Provider Demographics
NPI:1144221920
Name:SCHWIEDER, VIRGINIA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:ANN
Last Name:SCHWIEDER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 56TH STREET CT
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-3691
Mailing Address - Country:US
Mailing Address - Phone:309-762-7420
Mailing Address - Fax:
Practice Address - Street 1:5202 38TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6722
Practice Address - Country:US
Practice Address - Phone:309-736-7400
Practice Address - Fax:309-736-0361
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08130289OtherBCBS
IL1477120OtherFIRST HEALTH
IL1477120OtherFIRST HEALTH
IL706500Medicare ID - Type Unspecified