Provider Demographics
NPI:1497833636
Name:SCHNEIDER, COREY JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:JAMES
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 1:5261 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4903
Mailing Address - Country:US
Mailing Address - Phone:414-332-6001
Mailing Address - Fax:414-332-3712
Practice Address - Street 1:5261 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4903
Practice Address - Country:US
Practice Address - Phone:414-332-6001
Practice Address - Fax:414-332-3712
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3825-012111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI201717946OtherTAX ID
WIU88880Medicare UPIN