Provider Demographics
NPI:1891902383
Name:MORAN-SCHAEFER CLINIC
Entity type:Organization
Organization Name:MORAN-SCHAEFER CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-541-6648
Mailing Address - Street 1:1111 W DUNDEE RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-3936
Mailing Address - Country:US
Mailing Address - Phone:847-541-6648
Mailing Address - Fax:847-541-6647
Practice Address - Street 1:1111 W DUNDEE RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-3936
Practice Address - Country:US
Practice Address - Phone:847-541-6648
Practice Address - Fax:847-541-6647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006898111N00000X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1682407OtherBCBS
959800Medicare PIN
ILU25312Medicare UPIN