Provider Demographics
NPI:1043604978
Name:SCHULTZ, CORY (NDPHD)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:NDPHD
Other - Prefix:DR
Other - First Name:CURT
Other - Middle Name:
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NDPHD
Mailing Address - Street 1:2205 MARQUETTE RD
Mailing Address - Street 2:APT. C2
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-1523
Mailing Address - Country:US
Mailing Address - Phone:608-886-0563
Mailing Address - Fax:
Practice Address - Street 1:2205 MARQUETTE RD
Practice Address - Street 2:APT. C2
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-1523
Practice Address - Country:US
Practice Address - Phone:608-886-0563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-28
Last Update Date:2015-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043.113250164W00000X
ALS43211666069175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No164W00000XNursing Service ProvidersLicensed Practical Nurse