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General NPI Number Information
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NPI Number | 1730354234
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Entity Type | Organization
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Legal Business Name | SCHRADERLLC
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Dates
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Enumeration Date | 04/25/2008
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Last Update Date | 04/25/2008
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Provider Practice Location Address
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Address Line | 4055 BECK AVE
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City | LOUISVILLE
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State | OH
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Zip | 44641-9458
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Country | US
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Telephone | 330-875-2896
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Fax |
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Provider Business Mailing Address
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Address Line | 8008 PARIS AVE
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City | LOUISVILLE
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State | OH
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Zip | 44641-9526
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Country | US
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Telephone | 330-875-2896
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK ALLEN SCHRADER
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Credential | DC
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Telephone | 330-875-2896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2205
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License Number State | OH
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