Provider Demographics
NPI:1588793467
Name:SCHROEDER, SHARON RAE (DC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:RAE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 CEDAR LAKE RD S
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1481
Mailing Address - Country:US
Mailing Address - Phone:952-542-3908
Mailing Address - Fax:952-417-2486
Practice Address - Street 1:5801 CEDAR LAKE RD S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1481
Practice Address - Country:US
Practice Address - Phone:952-542-3908
Practice Address - Fax:952-417-2486
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3076111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN411984147OtherFEDERAL TAX I.D
MN3AT57SCOtherBCBS
MNC05273Medicare UPIN
MN3AT57SCOtherBCBS