1174742787 NPI number — FREDERICK M VANDERSCHAAF DC PA

Table of content: (NPI 1174742787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174742787 NPI number — FREDERICK M VANDERSCHAAF DC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREDERICK M VANDERSCHAAF DC PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174742787
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
982 DOUGLAS AVENUE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
ALTAMONTE SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32714-5201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-862-3900
Provider Business Mailing Address Fax Number:
407-862-7624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
982 DOUGLAS AVENUE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ALTAMONTE SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32714-5201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-862-3900
Provider Business Practice Location Address Fax Number:
407-862-7624
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VANDERSCHAAF
Authorized Official First Name:
FREDERICK
Authorized Official Middle Name:
MARTIN
Authorized Official Title or Position:
CHIROPRACTIC PHYSICIAN
Authorized Official Telephone Number:
407-862-3900

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH0003754 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 88848 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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