Provider Demographics
NPI:1538507579
Name:SCHMOLL, BRENDAN (DC)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:SCHMOLL
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 1:10445 BRIARBEND DR
Mailing Address - Street 2:APT 2
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-5696
Mailing Address - Country:US
Mailing Address - Phone:320-905-8440
Mailing Address - Fax:
Practice Address - Street 1:190 SPRING DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3255
Practice Address - Country:US
Practice Address - Phone:636-946-0799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013003631111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor