Provider Demographics
NPI:1104850445
Name:SCHMALL, MARK D (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:SCHMALL
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 1:3816 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6343
Mailing Address - Country:US
Mailing Address - Phone:309-797-3200
Mailing Address - Fax:309-797-3255
Practice Address - Street 1:3816 27TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6343
Practice Address - Country:US
Practice Address - Phone:309-797-3200
Practice Address - Fax:309-797-3255
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05584111N00000X
IL038-006653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor