Provider Demographics
NPI:1881675171
Name:SCHROEDER, JAMES MICHAEL (PC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226B CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-3231
Mailing Address - Country:US
Mailing Address - Phone:712-548-4000
Mailing Address - Fax:712-548-4000
Practice Address - Street 1:226B CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-3231
Practice Address - Country:US
Practice Address - Phone:712-548-4000
Practice Address - Fax:712-548-4000
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04978111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1218255Medicaid
21111OtherWELLMARK
IAI7696Medicare ID - Type Unspecified
IA1218255Medicaid