Provider Demographics
NPI:1124162367
Name:SCHENCK, WILLIAM J (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:SCHENCK
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:PO BOX 979
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-0979
Mailing Address - Country:US
Mailing Address - Phone:802-878-8330
Mailing Address - Fax:802-878-8344
Practice Address - Street 1:205 CORNERSTONE DR
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-4035
Practice Address - Country:US
Practice Address - Phone:802-878-8330
Practice Address - Fax:802-878-8344
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0000870111NN0400X, 111NN1001X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NN0400XChiropractic ProvidersChiropractorNeurology
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTSCH00018942OtherBCBS
VT03036OtherCBA
VT80705OtherGREAT WEST
VTT87083OtherCIGNA
VTVN0207Medicare ID - Type Unspecified