Provider Demographics
NPI:1891867511
Name:SCHROEDER, SCOTT R (DC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:R
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 1:3220 N ACADEMY BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5115
Mailing Address - Country:US
Mailing Address - Phone:719-591-2244
Mailing Address - Fax:719-591-1411
Practice Address - Street 1:3220 N ACADEMY BLVD STE 6
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5115
Practice Address - Country:US
Practice Address - Phone:719-591-2244
Practice Address - Fax:719-591-1411
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4631111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC49233Medicare PIN