Provider Demographics
NPI:1780602854
Name:SCHNEIDER, JON (DC)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:
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 1:1222 22ND AVE S
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2804
Mailing Address - Country:US
Mailing Address - Phone:605-696-7222
Mailing Address - Fax:605-692-6624
Practice Address - Street 1:1222 22ND AVE S
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2804
Practice Address - Country:US
Practice Address - Phone:605-696-7222
Practice Address - Fax:605-692-6624
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD956111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4995636OtherBLUE CROSS BLUE SHIELD
SD7601325Medicaid
SD350052590Medicare PIN
SD4995636OtherBLUE CROSS BLUE SHIELD