Provider Demographics
NPI:1992974604
Name:SCHMIDT, JOHN M (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
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 1:963 PLEASANT GROVE BLVD.
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678
Mailing Address - Country:US
Mailing Address - Phone:916-784-3321
Mailing Address - Fax:916-788-4242
Practice Address - Street 1:963 PLEASANT GROVE BLVD.
Practice Address - Street 2:SUITE 130
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678
Practice Address - Country:US
Practice Address - Phone:916-784-3321
Practice Address - Fax:916-788-4242
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA18629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1386860641OtherNPI
CA1386860641OtherNPI
CAT91107Medicare UPIN