Provider Demographics
NPI:1356400519
Name:SCHNEIDER, TIMOTHY PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PAUL
Last Name:SCHNEIDER
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 1:5401 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-2034
Mailing Address - Country:US
Mailing Address - Phone:262-681-8829
Mailing Address - Fax:262-681-8830
Practice Address - Street 1:5401 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53402-2034
Practice Address - Country:US
Practice Address - Phone:262-681-8829
Practice Address - Fax:262-681-8830
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3317-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38899500Medicaid
WI38899500Medicaid