Provider Demographics
NPI:1588691919
Name:SCHULTZ, KEVIN ELMER (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ELMER
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 1:1650 HALLIE RD
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-6521
Mailing Address - Country:US
Mailing Address - Phone:715-831-6052
Mailing Address - Fax:715-831-6141
Practice Address - Street 1:1650 HALLIE RD
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-6521
Practice Address - Country:US
Practice Address - Phone:715-831-6052
Practice Address - Fax:715-831-6141
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3766-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38934600Medicaid
WI0001Medicare ID - Type Unspecified
WIU87833Medicare UPIN