Provider Demographics
NPI:1760036008
Name:SCHULTZ, JESSE DAVID (DC)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:DAVID
Last Name:SCHULTZ
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 1:3501 MONTLIMAR PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609
Mailing Address - Country:US
Mailing Address - Phone:251-445-2295
Mailing Address - Fax:251-445-2299
Practice Address - Street 1:3501 MONTLIMAR PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609
Practice Address - Country:US
Practice Address - Phone:251-445-2295
Practice Address - Fax:251-445-2299
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor