Provider Demographics
NPI:1487631479
Name:SCHNEIDER, NORBERT EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:NORBERT
Middle Name:EDWARD
Last Name:SCHNEIDER
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 1:3851 PINE GROVE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-4217
Mailing Address - Country:US
Mailing Address - Phone:810-987-2938
Mailing Address - Fax:810-987-8204
Practice Address - Street 1:3851 PINE GROVE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-4217
Practice Address - Country:US
Practice Address - Phone:810-987-2938
Practice Address - Fax:810-987-8204
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINS002977111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950G450370OtherBLUE CROSS BLUE SHIELD
MI0G45037Medicare ID - Type Unspecified