Provider Demographics
NPI:1689683450
Name:SCHROEDER, MARCUS L (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:L
Last Name:SCHROEDER
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 1:1974 N HIGHWAY 190
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5158
Mailing Address - Country:US
Mailing Address - Phone:985-871-7411
Mailing Address - Fax:985-871-9726
Practice Address - Street 1:1974 N HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5158
Practice Address - Country:US
Practice Address - Phone:985-871-7411
Practice Address - Fax:985-871-9726
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1260111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4B976Medicare PIN