Provider Demographics
NPI:1578577938
Name:SCHMIDT, BRUCE (DC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:SCHMIDT
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 1:17250 N 43RD AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-4037
Mailing Address - Country:US
Mailing Address - Phone:623-842-1261
Mailing Address - Fax:623-334-0182
Practice Address - Street 1:17250 N 43RD AVE STE 5
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-4037
Practice Address - Country:US
Practice Address - Phone:623-842-1261
Practice Address - Fax:623-334-0192
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5951111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0935120OtherBCBS OF AZ PROVIDER#
AZ71504Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER