Provider Demographics
NPI:1326009507
Name:SCHAFER, JOHN A (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:SCHAFER
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 1:4089 W WALTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-4177
Mailing Address - Country:US
Mailing Address - Phone:248-674-5433
Mailing Address - Fax:248-674-5154
Practice Address - Street 1:4089 W WALTON BLVD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-4177
Practice Address - Country:US
Practice Address - Phone:248-674-5433
Practice Address - Fax:248-674-5154
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004796111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1684625Medicaid
MI0F35042-5951Medicare ID - Type UnspecifiedMEDICARE
MIU53806Medicare UPIN