Provider Demographics
NPI:1952546707
Name:SCHRAM CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:SCHRAM CHIROPRACTIC CLINIC PC
Other - Org Name:RICE CHIROPRACTIC LIFE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GALIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHRAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-233-1800
Mailing Address - Street 1:1009 LORAS DRIVE
Mailing Address - Street 2:SCHRAM CHIROPRACTIC CLINIC PC
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-6923
Mailing Address - Country:US
Mailing Address - Phone:815-233-1800
Mailing Address - Fax:815-235-7749
Practice Address - Street 1:1009 LORAS DRIVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-6923
Practice Address - Country:US
Practice Address - Phone:815-233-1800
Practice Address - Fax:815-235-7749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-004173111N00000X
IL060-010028111N00000X
IL038-003331111N00000X
IL038-005055111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty