Provider Demographics
NPI:1144238353
Name:SCHMIDT, MATTHEW EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:EDWARD
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 1:2406 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-4410
Mailing Address - Country:US
Mailing Address - Phone:309-662-8418
Mailing Address - Fax:309-662-8197
Practice Address - Street 1:2406 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-4410
Practice Address - Country:US
Practice Address - Phone:309-662-8418
Practice Address - Fax:309-662-8197
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL0100OtherJOHN DEERE HEALTH
IL071862OtherHEALTH ALLIANCE
IL5782014OtherBLUE CROSS BLUE SHIELD
IL5782014OtherBLUE CROSS BLUE SHIELD