Provider Demographics
NPI:1194276550
Name:SCHMICK, DYLAN E (MAL, LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:DYLAN
Middle Name:E
Last Name:SCHMICK
Suffix:
Gender:M
Credentials:MAL, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 75
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:WA
Mailing Address - Zip Code:99125
Mailing Address - Country:US
Mailing Address - Phone:509-953-1398
Mailing Address - Fax:
Practice Address - Street 1:1910 UNIVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83725
Practice Address - Country:US
Practice Address - Phone:509-953-1398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-5462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDAT-546OtherIDAHO STATE BOARD OF MEDICINE