Provider Demographics
NPI:1568708261
Name:SCHRADER, GREGORY C (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:C
Last Name:SCHRADER
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 1:9457 DAVID SMITH LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-7292
Mailing Address - Country:US
Mailing Address - Phone:423-238-4118
Mailing Address - Fax:423-238-6565
Practice Address - Street 1:9457 DAVID SMITH LN
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-7292
Practice Address - Country:US
Practice Address - Phone:423-238-4118
Practice Address - Fax:423-238-6565
Is Sole Proprietor?:No
Enumeration Date:2012-12-27
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC1767111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor