Provider Demographics
NPI:1619021441
Name:SCHUDAR-SVEC, PAMELA (DC)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:
Last Name:SCHUDAR-SVEC
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6514 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-8521
Mailing Address - Country:US
Mailing Address - Phone:208-267-7355
Mailing Address - Fax:208-267-7355
Practice Address - Street 1:6514 MAIN ST
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-8521
Practice Address - Country:US
Practice Address - Phone:208-267-7355
Practice Address - Fax:208-267-7355
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010150766OtherBLUE SHIELD OF IDAHO
IDC5649OtherBLUE CROSS OF IDAHO
U61074Medicare UPIN
1670451Medicare ID - Type Unspecified