Provider Demographics
NPI:1750305942
Name:SCHIBONSKI, DALE R
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:R
Last Name:SCHIBONSKI
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 1:7435 CHURCH ROAD
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401
Mailing Address - Country:US
Mailing Address - Phone:218-825-0427
Mailing Address - Fax:
Practice Address - Street 1:7435 CHURCH RD
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-6461
Practice Address - Country:US
Practice Address - Phone:218-825-0427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN114950OtherHEALTH PARTNERS
MN167865OtherUCARE
MN7B836SCOtherBCBS
MN1010860OtherPREFERRED ONE
MN6202834OtherMEDICA