Provider Demographics
NPI:1871662965
Name:SCHROEDER, WILLIAM G (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:G
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 1:313 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08835-1840
Mailing Address - Country:US
Mailing Address - Phone:908-707-0050
Mailing Address - Fax:908-707-8848
Practice Address - Street 1:313 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08835-1840
Practice Address - Country:US
Practice Address - Phone:908-707-0050
Practice Address - Fax:908-707-8848
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00320400111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
4316788OtherAETNA PROV #
U24647Medicare UPIN
4316788OtherAETNA PROV #