Provider Demographics
NPI:1235602855
Name:SCHIMMELPFENNIG, JILL MARIE (LAC, MSOM)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:MARIE
Last Name:SCHIMMELPFENNIG
Suffix:
Gender:F
Credentials:LAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 S DUNN ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5928
Mailing Address - Country:US
Mailing Address - Phone:812-320-3032
Mailing Address - Fax:
Practice Address - Street 1:357 S LANDMARK AVE STE B
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-5002
Practice Address - Country:US
Practice Address - Phone:812-334-5815
Practice Address - Fax:812-339-8352
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000146A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist