Provider Demographics
NPI:1851429633
Name:SCHNEEKLOTH, TYLER GEORGE (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:GEORGE
Last Name:SCHNEEKLOTH
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 1:100 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:WI
Mailing Address - Zip Code:53594-1273
Mailing Address - Country:US
Mailing Address - Phone:920-478-4477
Mailing Address - Fax:920-478-4477
Practice Address - Street 1:100 E MADISON ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:WI
Practice Address - Zip Code:53594-1273
Practice Address - Country:US
Practice Address - Phone:920-478-4477
Practice Address - Fax:920-478-4477
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3425-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38901200Medicaid
WIU66026Medicare UPIN
WI70745Medicare PIN