Provider Demographics
NPI:1336221225
Name:SCHROEDER, LORI (DC)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 E BULLARD AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5476
Mailing Address - Country:US
Mailing Address - Phone:559-439-4904
Mailing Address - Fax:559-439-5051
Practice Address - Street 1:720 E BULLARD AVE
Practice Address - Street 2:STE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5476
Practice Address - Country:US
Practice Address - Phone:559-439-4904
Practice Address - Fax:559-439-5051
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16854111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 0016854Medicare ID - Type Unspecified