Provider Demographics
NPI:1669948048
Name:SCHOONOVER, CALEB
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:SCHOONOVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 32ND AVE S
Mailing Address - Street 2:STE 103
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5998
Mailing Address - Country:US
Mailing Address - Phone:701-775-1034
Mailing Address - Fax:701-775-8241
Practice Address - Street 1:3750 32ND AVE S STE 103
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5998
Practice Address - Country:US
Practice Address - Phone:701-775-1034
Practice Address - Fax:701-775-8241
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1091111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor