Provider Demographics
NPI:1639511769
Name:SCHMIDT, KELLY JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:JAMES
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 1:1320 11TH ST NW
Mailing Address - Street 2:SUITE F
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5071
Mailing Address - Country:US
Mailing Address - Phone:563-559-2115
Mailing Address - Fax:563-559-2117
Practice Address - Street 1:1320 11TH ST NW
Practice Address - Street 2:SUITE F
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5071
Practice Address - Country:US
Practice Address - Phone:563-559-2115
Practice Address - Fax:563-559-2117
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor