Provider Demographics
NPI:1194953091
Name:SCHMIDT, DAVID C (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:SCHMIDT
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:PO BOX 842
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-0842
Mailing Address - Country:US
Mailing Address - Phone:651-208-9972
Mailing Address - Fax:
Practice Address - Street 1:13411 MAXWELL RD
Practice Address - Street 2:
Practice Address - City:CHISAGO CITY
Practice Address - State:MN
Practice Address - Zip Code:55013-7346
Practice Address - Country:US
Practice Address - Phone:651-208-9972
Practice Address - Fax:651-213-1225
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1932430907Medicare UPIN