Provider Demographics
NPI:1982743035
Name:SCHROEDER, ANDREW GORDON (DOCTOR OF CHIROPRACT)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:GORDON
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:DOCTOR OF CHIROPRACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7191 N MILLBROOK
Mailing Address - Street 2:SUITE 116
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720
Mailing Address - Country:US
Mailing Address - Phone:559-432-2225
Mailing Address - Fax:559-432-2239
Practice Address - Street 1:7191 N MILLBROOK
Practice Address - Street 2:SUITE 116
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-432-2225
Practice Address - Fax:559-432-2239
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA0012052111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T04602Medicare UPIN