Provider Demographics
NPI:1295904035
Name:VANDERSCHAAF, FREDERICK M (DC, DABCO, FIAMA)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:M
Last Name:VANDERSCHAAF
Suffix:
Gender:M
Credentials:DC, DABCO, FIAMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 DOUGLAS AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-5201
Mailing Address - Country:US
Mailing Address - Phone:407-862-3900
Mailing Address - Fax:407-862-7624
Practice Address - Street 1:982 DOUGLAS AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-5201
Practice Address - Country:US
Practice Address - Phone:407-862-3900
Practice Address - Fax:407-862-7624
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3754111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT96761Medicare UPIN