Provider Demographics
NPI:1215025051
Name:SCHRODER, JAMES LYLE (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LYLE
Last Name:SCHRODER
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 1:3372 KEITH ST NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3718
Mailing Address - Country:US
Mailing Address - Phone:423-476-4751
Mailing Address - Fax:423-339-2692
Practice Address - Street 1:3372 KEITH ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3718
Practice Address - Country:US
Practice Address - Phone:423-476-4751
Practice Address - Fax:423-339-2692
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN001123111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3677742Medicare ID - Type Unspecified
TNU55194Medicare UPIN