Provider Demographics
NPI:1154689834
Name:SCHMIDT, LYDIA (DC)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CREEK LN S
Mailing Address - Street 2:
Mailing Address - City:JORDAN
Mailing Address - State:MN
Mailing Address - Zip Code:55352-1202
Mailing Address - Country:US
Mailing Address - Phone:952-492-6363
Mailing Address - Fax:952-492-5129
Practice Address - Street 1:108 CREEK LN S
Practice Address - Street 2:
Practice Address - City:JORDAN
Practice Address - State:MN
Practice Address - Zip Code:55352-1202
Practice Address - Country:US
Practice Address - Phone:952-492-6363
Practice Address - Fax:952-492-5129
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor