Provider Demographics
NPI:1629040373
Name:SCHMIDT, PAUL K
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:K
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 MADISON AVE
Mailing Address - Street 2:301
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-3146
Mailing Address - Country:US
Mailing Address - Phone:916-331-7878
Mailing Address - Fax:916-331-7945
Practice Address - Street 1:5301 MADISON AVE
Practice Address - Street 2:301
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-3146
Practice Address - Country:US
Practice Address - Phone:916-331-7878
Practice Address - Fax:916-331-7945
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 12273111N00000X, 111NX0100X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT04698OtherHILL PHYSICIAN MED GROUP
CADC0122730Medicare ID - Type UnspecifiedCHIROPRACTIC PROVIDER