Provider Demographics
NPI:1831374180
Name:SCHNEIDER CLINIC P.C.
Entity type:Organization
Organization Name:SCHNEIDER CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:574-293-7000
Mailing Address - Street 1:1178 FREMONT CT
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-9321
Mailing Address - Country:US
Mailing Address - Phone:574-293-7000
Mailing Address - Fax:574-293-7004
Practice Address - Street 1:1178 FREMONT CT
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-9321
Practice Address - Country:US
Practice Address - Phone:574-293-7000
Practice Address - Fax:574-293-7004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100113340AMedicaid
IN200020Medicare PIN