Provider Demographics
NPI:1063504587
Name:SCHMIDT, FRED T (DC)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:T
Last Name:SCHMIDT
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 1:4150 MERRICK RD STE D
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6028
Mailing Address - Country:US
Mailing Address - Phone:516-799-8888
Mailing Address - Fax:516-799-8888
Practice Address - Street 1:4150 MERRICK RD STE D
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6028
Practice Address - Country:US
Practice Address - Phone:516-799-8888
Practice Address - Fax:516-799-8888
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX8396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor