Provider Demographics
NPI:1982611596
Name:SCHULMAN, JACK ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:ALLEN
Last Name:SCHULMAN
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 1:8003 WEST CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082
Mailing Address - Country:US
Mailing Address - Phone:610-446-5777
Mailing Address - Fax:
Practice Address - Street 1:8003 WEST CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082
Practice Address - Country:US
Practice Address - Phone:610-446-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001581L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4540431OtherAETNA-PPO
PA085065OtherBLUE CROSS/BLUE SHIELD
PA0032850000OtherBLUE CROSS/BLUESHIELD
PA99945OtherAETNA-HMO
PA0032850000OtherBLUE CROSS/BLUESHIELD