Provider Demographics
NPI:1225088610
Name:SCHMUTZ, JEREMY JOSEPH (DC)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:JOSEPH
Last Name:SCHMUTZ
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 1:501 E MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COUNCIL GROVE
Mailing Address - State:KS
Mailing Address - Zip Code:66846-1355
Mailing Address - Country:US
Mailing Address - Phone:620-767-5282
Mailing Address - Fax:620-767-5292
Practice Address - Street 1:501 E MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:COUNCIL GROVE
Practice Address - State:KS
Practice Address - Zip Code:66846-1355
Practice Address - Country:US
Practice Address - Phone:620-767-5282
Practice Address - Fax:620-767-5292
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060969Medicare ID - Type Unspecified
KSU83761Medicare UPIN