Provider Demographics
NPI:1992706592
Name:SCHULTZ, MARY B (DC)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:B
Last Name:SCHULTZ
Suffix:
Gender:F
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:N9320 STATE ROAD 49
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54945-9424
Mailing Address - Country:US
Mailing Address - Phone:715-445-4777
Mailing Address - Fax:
Practice Address - Street 1:310 N MAIN ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:WI
Practice Address - Zip Code:54945-9492
Practice Address - Country:US
Practice Address - Phone:715-445-4002
Practice Address - Fax:715-445-4390
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2569111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38845000Medicaid
WI70781Medicare ID - Type Unspecified
WIT90685Medicare UPIN