Provider Demographics
NPI:1235524620
Name:SCHMIDGALL, JEFFREY DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DANIEL
Last Name:SCHMIDGALL
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 1:1932 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:IL
Mailing Address - Zip Code:61530-1666
Mailing Address - Country:US
Mailing Address - Phone:309-467-5000
Mailing Address - Fax:309-467-5100
Practice Address - Street 1:1932 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:IL
Practice Address - Zip Code:61530-1666
Practice Address - Country:US
Practice Address - Phone:309-467-5000
Practice Address - Fax:309-467-5100
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor