Provider Demographics
NPI:1659304525
Name:SCHNEIDER, MARK ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
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 1:1178 FREMONT CT
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-9321
Mailing Address - Country:US
Mailing Address - Phone:574-293-7000
Mailing Address - Fax:574-293-7004
Practice Address - Street 1:1178 FREMONT CT
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-9321
Practice Address - Country:US
Practice Address - Phone:574-293-7000
Practice Address - Fax:574-293-7004
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100113340AMedicaid
IN000000276845OtherANTHEM BCBS PROVIDER #
IN4354978OtherAETNA PROVIDER #
IN100113340AMedicaid