Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 165000214 | IL |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 038006898 | IL |
NPI | 1417930686 |
---|---|
Provider Name | Dr. Richard A. Schaefer |
First Address | Wheeling, IL 60090-3936 |
Second Address | Wheeling, IL 60090-3936 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 26/03/2020 |