Provider Demographics
NPI:1043517394
Name:SCHMIDT, ELENA SUE (DC)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:SUE
Last Name:SCHMIDT
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 1:2608 NE SANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2342
Mailing Address - Country:US
Mailing Address - Phone:503-719-4326
Mailing Address - Fax:503-719-4328
Practice Address - Street 1:2608 NE SANDY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2342
Practice Address - Country:US
Practice Address - Phone:503-719-4326
Practice Address - Fax:503-719-4328
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4088111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor