Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | K01-69-1153 | KS |
NPI | 1003890922 |
---|---|
Provider Name | Dr. Jeffrey Kent Schroeder |
First Address | Lawrence, KS 66044-1709 |
Second Address | Lawrence, KS 66044-1709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2005 |
Last Update Date | 29/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U29013 | (02) | KS |