Provider Demographics
NPI:1669541140
Name:SCHNEIDER, DOUGLAS RAY (DC)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:RAY
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2593 CANTON RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-5390
Mailing Address - Country:US
Mailing Address - Phone:770-424-9555
Mailing Address - Fax:770-499-7101
Practice Address - Street 1:2593 CANTON RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-5390
Practice Address - Country:US
Practice Address - Phone:770-424-9555
Practice Address - Fax:770-499-7101
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor