Provider Demographics
NPI:1629155783
Name:SCHNEIDER, DAVID K (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:K
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 1:2696 NOEL DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-6729
Mailing Address - Country:US
Mailing Address - Phone:920-465-9020
Mailing Address - Fax:920-465-9020
Practice Address - Street 1:2696 NOEL DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6729
Practice Address - Country:US
Practice Address - Phone:920-465-9020
Practice Address - Fax:920-465-9020
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38851600Medicaid
WI391989684017OtherBLUECROSS BLUESHIELD
WI38851600Medicaid