Provider Demographics
NPI:1366472094
Name:SCHIMKE-JONES, NICOLE RENE (DC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENE
Last Name:SCHIMKE-JONES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:RENE
Other - Last Name:FYNAARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:W 309 S 4860 COMMERCIAL DRIVE
Mailing Address - Street 2:STE B
Mailing Address - City:NORTH PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53153
Mailing Address - Country:US
Mailing Address - Phone:262-968-9891
Mailing Address - Fax:262-968-9782
Practice Address - Street 1:W 309 S 4860 COMMERCIAL DRIVE
Practice Address - Street 2:STE B
Practice Address - City:NORTH PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53153
Practice Address - Country:US
Practice Address - Phone:262-968-9891
Practice Address - Fax:262-968-9782
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38857900Medicaid
WI70767Medicare ID - Type Unspecified
U28485Medicare UPIN