Provider Demographics
NPI:1003698903
Name:SCHILDT, JACQUELYN VICTORIA
Entity Type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:VICTORIA
Last Name:SCHILDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4727 N 26TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-4706
Mailing Address - Country:US
Mailing Address - Phone:402-438-2090
Mailing Address - Fax:
Practice Address - Street 1:4727 N 26TH ST STE D
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4706
Practice Address - Country:US
Practice Address - Phone:402-438-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor