Provider Demographics
NPI:1316129679
Name:SCHROETER, KEVIN THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:THOMAS
Last Name:SCHROETER
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 1:641 NEWMAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-1721
Mailing Address - Country:US
Mailing Address - Phone:732-933-4446
Mailing Address - Fax:732-933-1622
Practice Address - Street 1:641 NEWMAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LINCROFT
Practice Address - State:NJ
Practice Address - Zip Code:07738-1721
Practice Address - Country:US
Practice Address - Phone:732-933-4446
Practice Address - Fax:732-933-1622
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00600500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0063924Medicaid
NJ089758Medicare PIN
NJ089761T3PMedicare UPIN