Provider Demographics
NPI:1285729079
Name:SCHULZ, BRENTON GARRICK (DC)
Entity type:Individual
Prefix:DR
First Name:BRENTON
Middle Name:GARRICK
Last Name:SCHULZ
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 1:3701 HIGHWAY 59
Mailing Address - Street 2:SUITE D
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-1905
Mailing Address - Country:US
Mailing Address - Phone:985-809-3135
Mailing Address - Fax:985-809-3035
Practice Address - Street 1:3701 HIGHWAY 59
Practice Address - Street 2:SUITE D
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-1905
Practice Address - Country:US
Practice Address - Phone:985-809-3135
Practice Address - Fax:985-809-3035
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAU87147Medicare UPIN