MEDICARE: SHARON RAE SCHROEDER 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	3076	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	411984147	OTHER	MN	FEDERAL TAX I.D
2	3AT57SC	OTHER	MN	BCBS

General Provider Information

NPI Number	:	1588793467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON RAE SCHROEDER D.C

Provider Business Mailing Address
First Line	:	5801 CEDAR LAKE RD S
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1481
Country	:	US
Telephone Number	:	952-542-3908
Fax Number	:	952-417-2486

Provider Business Practice Location Address
First Line	:	5801 CEDAR LAKE RD S
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1481
Country	:	US
Telephone Number	:	952-542-3908
Fax Number	:	952-417-2486

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/15/2009

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