Provider Demographics
NPI:1386773380
Name:SCHILLER, DAVID S (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:SCHILLER
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 1:25 BAILEY RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3671
Mailing Address - Country:US
Mailing Address - Phone:860-676-9660
Mailing Address - Fax:860-676-9159
Practice Address - Street 1:25 BAILEY RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3671
Practice Address - Country:US
Practice Address - Phone:860-676-9660
Practice Address - Fax:860-676-9159
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000939111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050000939CT02OtherANTHEM BC BS OF CT
CT050000939CT02OtherANTHEM BC BS OF CT