Provider Demographics
NPI:1598846305
Name:VANDERSCHAAF, BRUCE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:VANDERSCHAAF
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 1:1144 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-9040
Mailing Address - Country:US
Mailing Address - Phone:630-554-9323
Mailing Address - Fax:630-554-9328
Practice Address - Street 1:1144 DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-9040
Practice Address - Country:US
Practice Address - Phone:630-554-9323
Practice Address - Fax:630-554-9328
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005174111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL742990Medicare ID - Type Unspecified
ILT38407Medicare UPIN