Provider Demographics
NPI:1124195110
Name:SCHNEIDER, BRUCE STEPHEN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:STEPHEN
Last Name:SCHNEIDER
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 1:1429 ENCHANTED OAKS DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-9011
Mailing Address - Country:US
Mailing Address - Phone:919-755-1429
Mailing Address - Fax:
Practice Address - Street 1:81 GLEN RD STE 9
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7943
Practice Address - Country:US
Practice Address - Phone:919-661-2225
Practice Address - Fax:919-661-2226
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4384772OtherAETNA
NC0829ROtherBLUE CROSS BLUE SHIELD
NC890829RMedicaid
NC4384772OtherAETNA
NC890829RMedicaid