Provider Demographics
NPI:1164714523
Name:SCHMOE, JEREMIAH RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:RYAN
Last Name:SCHMOE
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 1:13911 RIDGEDALE DR STE 490
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1772
Mailing Address - Country:US
Mailing Address - Phone:612-223-8590
Mailing Address - Fax:
Practice Address - Street 1:13911 RIDGEDALE DR STE 490
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1772
Practice Address - Country:US
Practice Address - Phone:612-223-8590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5531111NN0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN0400XChiropractic ProvidersChiropractorNeurology