Provider Demographics
NPI:1053304535
Name:SCHULTZ, JOANNA MOREY (DC CCSP CCP)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:MOREY
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:DC CCSP CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24W500 MAPLE AVE
Mailing Address - Street 2:#105
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6055
Mailing Address - Country:US
Mailing Address - Phone:630-428-4300
Mailing Address - Fax:630-428-4205
Practice Address - Street 1:24W500 MAPLE AVE
Practice Address - Street 2:#105
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6055
Practice Address - Country:US
Practice Address - Phone:630-428-4300
Practice Address - Fax:630-428-4205
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
L98166Medicare ID - Type Unspecified
U94907Medicare UPIN