Provider Demographics
NPI:1407560063
Name:SCHRAD, TANNER (DC)
Entity Type:Individual
Prefix:DR
First Name:TANNER
Middle Name:
Last Name:SCHRAD
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 1:608 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51449-1545
Mailing Address - Country:US
Mailing Address - Phone:712-790-1073
Mailing Address - Fax:
Practice Address - Street 1:608 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:IA
Practice Address - Zip Code:51449-1545
Practice Address - Country:US
Practice Address - Phone:712-790-1073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA117039111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor