Provider Demographics
NPI:1457655219
Name:SCHOONMAKER, TORY
Entity Type:Individual
Prefix:
First Name:TORY
Middle Name:
Last Name:SCHOONMAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4856 TRAIL HOLLOW DR
Mailing Address - Street 2:TX
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76244
Mailing Address - Country:US
Mailing Address - Phone:817-800-8508
Mailing Address - Fax:
Practice Address - Street 1:4856 TRAIL HOLLOW DR
Practice Address - Street 2:TX
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76244
Practice Address - Country:US
Practice Address - Phone:817-800-8508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB142491Medicare PIN