Healthcare Provider Details

I. General information

NPI: 1316194376
Provider Name (Legal Business Name): EMILY SUE SCHADLER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3760 SIXES RD SUITE 120
CANTON GA
30114-8192
US

IV. Provider business mailing address

3760 SIXES RD SUITE 120
CANTON GA
30114-8192
US

V. Phone/Fax

Practice location:
  • Phone: 770-704-4580
  • Fax:
Mailing address:
  • Phone: 770-704-4580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIRO005505
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: