Provider Demographics
NPI:1093859837
Name:SCHAEFER, DWIGHT DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:DAVID
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15610 N 35TH AVE
Mailing Address - Street 2:STE 11
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-3838
Mailing Address - Country:US
Mailing Address - Phone:602-548-6100
Mailing Address - Fax:
Practice Address - Street 1:15610 N 35TH AVE
Practice Address - Street 2:STE 11
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-3838
Practice Address - Country:US
Practice Address - Phone:602-548-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T33914Medicare UPIN
AZZDC3436Medicare PIN