Provider Demographics
NPI:1043248008
Name:SCHRAM, BRIAN LANE (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:LANE
Last Name:SCHRAM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 E HORSETOOTH RD #3
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5726
Mailing Address - Country:US
Mailing Address - Phone:970-226-6676
Mailing Address - Fax:970-226-6677
Practice Address - Street 1:1424 E HORSETOOTH RD #3
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5726
Practice Address - Country:US
Practice Address - Phone:970-226-6676
Practice Address - Fax:970-226-6677
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1862-3Medicare ID - Type Unspecified
U 03248Medicare UPIN