MEDICARE: CONNIE RUTH SCHRODER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	392	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000117579	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1376536227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNIE RUTH SCHRODER D.C.

Provider Business Mailing Address
First Line	:	497 NORTH ST
Second Line	:
City	:	DUNCAN FALLS
State	:	OH
Zip	:	43734-9729
Country	:	US
Telephone Number	:	740-674-6344
Fax Number	:	740-674-6344

Provider Business Practice Location Address
First Line	:	497 NORTH ST
Second Line	:
City	:	DUNCAN FALLS
State	:	OH
Zip	:	43734-9729
Country	:	US
Telephone Number	:	740-674-6344
Fax Number	:	740-674-6344

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	07/08/2007

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