Provider Demographics
NPI:1619971405
Name:SCHMIDT, KRISTAL (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTAL
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KRISTAL
Other - Middle Name:KAY
Other - Last Name:VANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:201 W LAKEWAY RD
Mailing Address - Street 2:STE 200
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-6341
Mailing Address - Country:US
Mailing Address - Phone:307-682-7885
Mailing Address - Fax:307-682-2153
Practice Address - Street 1:201 W LAKEWAY RD
Practice Address - Street 2:STE 200
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-6341
Practice Address - Country:US
Practice Address - Phone:307-682-7885
Practice Address - Fax:307-682-2153
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY674111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY801230Medicare PIN