Provider Demographics
NPI:1548485519
Name:SCHRAMM, KENNETH LYLE (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LYLE
Last Name:SCHRAMM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:KENNETH
Other - Middle Name:L
Other - Last Name:SCHRAMM, D.C., P.A.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PROFESSIONAL ASSOC
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:BLANCO
Mailing Address - State:TX
Mailing Address - Zip Code:78606-0145
Mailing Address - Country:US
Mailing Address - Phone:830-833-0889
Mailing Address - Fax:
Practice Address - Street 1:405 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLANCO
Practice Address - State:TX
Practice Address - Zip Code:78606
Practice Address - Country:US
Practice Address - Phone:830-833-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT15779Medicare UPIN
TX601773Medicare ID - Type Unspecified