Provider Demographics
NPI:1679566723
Name:SCHRODER, DAVID EUGENE (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EUGENE
Last Name:SCHRODER
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 1:300 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-3426
Mailing Address - Country:US
Mailing Address - Phone:740-454-1747
Mailing Address - Fax:740-454-6742
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-3426
Practice Address - Country:US
Practice Address - Phone:740-454-1747
Practice Address - Fax:740-454-6742
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000117580OtherANTHEM
OH0262148Medicaid
OH0412152Medicare PIN
OH000000117580OtherANTHEM