Healthcare Provider Details

I. General information

NPI: 1417930686
Provider Name (Legal Business Name): RICHARD A. SCHAEFER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W DUNDEE RD
WHEELING IL
60090-3936
US

IV. Provider business mailing address

1111 W DUNDEE RD
WHEELING IL
60090-3936
US

V. Phone/Fax

Practice location:
  • Phone: 847-541-6648
  • Fax: 847-541-6649
Mailing address:
  • Phone: 847-541-6648
  • Fax: 847-541-6649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number038006898
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number165000214
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: