Provider Demographics
NPI:1063562338
Name:SCHAEFFER, SCOTT D (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:SCHAEFFER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 JAMES DR
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-9039
Mailing Address - Country:US
Mailing Address - Phone:610-867-1907
Mailing Address - Fax:
Practice Address - Street 1:35 E ELIZABETH AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6505
Practice Address - Country:US
Practice Address - Phone:610-867-1907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006394L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU63043Medicare UPIN
PA094954Medicare ID - Type Unspecified