Provider Demographics
NPI:1639467343
Name:SCHAEFER, MARCIA L (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:L
Last Name:SCHAEFER
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 1:602 CORNER ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:WI
Mailing Address - Zip Code:53555-1109
Mailing Address - Country:US
Mailing Address - Phone:608-592-2763
Mailing Address - Fax:
Practice Address - Street 1:602 CORNER ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:WI
Practice Address - Zip Code:53555-1109
Practice Address - Country:US
Practice Address - Phone:608-592-2763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4673-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor