Provider Demographics
NPI:1073594438
Name:BECK-SCHMIDT, JENNIFER (DC, RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BECK-SCHMIDT
Suffix:
Gender:F
Credentials:DC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3760 SADDLEBACK RD
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-4800
Mailing Address - Country:US
Mailing Address - Phone:801-560-1581
Mailing Address - Fax:
Practice Address - Street 1:3760 SADDLEBACK RD
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-4800
Practice Address - Country:US
Practice Address - Phone:801-560-1581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT368796-3102163W00000X
UT368796-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU74740Medicare UPIN
UT000056238Medicare ID - Type Unspecified