Provider Demographics
NPI:1215970520
Name:SCHULTZ, CHAD WAYNE (DC)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:WAYNE
Last Name:SCHULTZ
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 1:2837 DARLING COURT
Mailing Address - Street 2:
Mailing Address - City:LACROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54650
Mailing Address - Country:US
Mailing Address - Phone:608-783-3040
Mailing Address - Fax:844-248-2389
Practice Address - Street 1:2837 DARLING COURT
Practice Address - Street 2:
Practice Address - City:LACROSSE
Practice Address - State:WI
Practice Address - Zip Code:54650
Practice Address - Country:US
Practice Address - Phone:608-783-3040
Practice Address - Fax:844-248-2389
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3426111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38932600Medicaid
WIP00044509OtherRAILROAD MEDICARE PIN
WIP00044509OtherRAILROAD MEDICARE PIN
WI000235915Medicare PIN