MEDICARE: DR. COREY JAMES SCHNEIDER 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	111NR0400X	Rehabilitation Chiropractor	3825-012	WI
2	111NS0005X	Sports Physician Chiropractor	3825-012	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	201717946	OTHER	WI	TAX ID

General Provider Information

NPI Number	:	1497833636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COREY JAMES SCHNEIDER D.C.

Provider Business Mailing Address
First Line	:	5261 N PORT WASHINGTON RD
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53217-4903
Country	:	US
Telephone Number	:	414-332-6001
Fax Number	:	414-332-3712

Provider Business Practice Location Address
First Line	:	5261 N PORT WASHINGTON RD
Second Line	:	SUITE 101
City	:	GLENDALE
State	:	WI
Zip	:	53217-4903
Country	:	US
Telephone Number	:	414-332-6001
Fax Number	:	414-332-3712

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	09/02/2011

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