Provider Demographics
NPI:1033266317
Name:SCHULZ, NATHAN TROY (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:TROY
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 1:925 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55041-1856
Mailing Address - Country:US
Mailing Address - Phone:651-345-5615
Mailing Address - Fax:651-345-4005
Practice Address - Street 1:925 S OAK ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MN
Practice Address - Zip Code:55041-1856
Practice Address - Country:US
Practice Address - Phone:651-345-5615
Practice Address - Fax:651-345-4005
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3824111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN775S2SCOtherBCBS PIN NUMBER
MNP00260906OtherPALMETTO GBA PIN NUMBER
MNDD9286OtherPALMETTO GBA GROUP NUMBER
MNP00260906OtherPALMETTO GBA PIN NUMBER
MNC03475Medicare PIN