Provider Demographics
NPI:1720063548
Name:SCHNEIDER, SHERRY LYNN (DC,CACCP)
Entity type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:LYNN
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:DC,CACCP
Other - Prefix:DR
Other - First Name:SHERRY
Other - Middle Name:
Other - Last Name:SANDSTEDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC, CACCP
Mailing Address - Street 1:7420 CLAIREMONT MESA BLVD. SUITE 120
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111
Mailing Address - Country:US
Mailing Address - Phone:858-514-8204
Mailing Address - Fax:858-514-8207
Practice Address - Street 1:7420 CLAIREMONT MESA BLVD. SUITE 120
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111
Practice Address - Country:US
Practice Address - Phone:858-514-8204
Practice Address - Fax:858-514-8207
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034520111N00000X
CA30335111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8857666Medicare PIN
V07654Medicare UPIN