Provider Demographics
NPI:1568455715
Name:SCHRODER, RUSSEL E (DC)
Entity Type:Individual
Prefix:
First Name:RUSSEL
Middle Name:E
Last Name:SCHRODER
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 1:300 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-3426
Mailing Address - Country:US
Mailing Address - Phone:740-454-1747
Mailing Address - Fax:740-454-6742
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-3426
Practice Address - Country:US
Practice Address - Phone:740-454-1747
Practice Address - Fax:740-454-6742
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000341951OtherANTHEM
OH2244637Medicaid
OH4209781Medicare PIN
OH2244637Medicaid