Healthcare Provider Details

I. General information

NPI: 1205871332
Provider Name (Legal Business Name): RANDAL GENE SCHAETZKE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 4 WATERMAN PLACE WATERMAN HILL
QUECHEE VT
05059
US

IV. Provider business mailing address

PO BOX 628
QUECHEE VT
05059-0628
US

V. Phone/Fax

Practice location:
  • Phone: 802-296-6030
  • Fax: 802-296-7048
Mailing address:
  • Phone: 802-296-6030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number945
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: