Provider Demographics
NPI:1508964776
Name:SCHERMERHORN, JACK W (DC)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:W
Last Name:SCHERMERHORN
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 1:2517 SOUTH AVE
Mailing Address - Street 2:SCHERMERHORN CHIROPRACTIC
Mailing Address - City:LACROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601
Mailing Address - Country:US
Mailing Address - Phone:608-787-8000
Mailing Address - Fax:608-787-8003
Practice Address - Street 1:2517 SOUTH AVE
Practice Address - Street 2:SCHERMERHORN CHIROPRACTIC
Practice Address - City:LACROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601
Practice Address - Country:US
Practice Address - Phone:608-787-8000
Practice Address - Fax:608-787-8003
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1676111N00000X
MN2465111N00000X
MN002465171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4797820OtherTAX ID
WI391396774OtherTAX ID
MN4797820OtherTAX ID