Provider Demographics
NPI:1265507651
Name:SCHOMAKER CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:SCHOMAKER CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TROY
Authorized Official - Last Name:SCHOMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, BS
Authorized Official - Phone:763-253-2000
Mailing Address - Street 1:19022 FREEPORT ST. NW
Mailing Address - Street 2:SUITE D
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330
Mailing Address - Country:US
Mailing Address - Phone:763-253-2000
Mailing Address - Fax:762-241-2191
Practice Address - Street 1:19022 FREEPORT ST. NW
Practice Address - Street 2:SUITE D
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330
Practice Address - Country:US
Practice Address - Phone:763-253-2000
Practice Address - Fax:762-241-2191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3405111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU62239Medicare UPIN