Provider Demographics
NPI:1689730889
Name:SCHMIDT, MARY ROXANNE (DC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ROXANNE
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 1:310 CLEVELAND AVE SE
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3310
Mailing Address - Country:US
Mailing Address - Phone:360-943-6015
Mailing Address - Fax:360-943-2807
Practice Address - Street 1:310 CLEVELAND AVE SE
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-3310
Practice Address - Country:US
Practice Address - Phone:360-943-6015
Practice Address - Fax:360-943-2807
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB06165Medicare ID - Type Unspecified