Provider Demographics
NPI:1578098760
Name:SCHMIDT, JORDAN (DC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 8TH ST NW # 100
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-5927
Mailing Address - Country:US
Mailing Address - Phone:507-424-0655
Mailing Address - Fax:
Practice Address - Street 1:2207 OKOBOJI AVE STE F
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:IA
Practice Address - Zip Code:51351-1293
Practice Address - Country:US
Practice Address - Phone:712-338-2225
Practice Address - Fax:712-338-2578
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098863111N00000X
MN6365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor