Provider Demographics
NPI:1851463293
Name:SCHMOLL, DALE GREGORY (DC)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:GREGORY
Last Name:SCHMOLL
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 1:28689 HUB DR
Mailing Address - Street 2:
Mailing Address - City:MADISON LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56063-4179
Mailing Address - Country:US
Mailing Address - Phone:507-330-1072
Mailing Address - Fax:
Practice Address - Street 1:200 E BOWLER ST
Practice Address - Street 2:
Practice Address - City:LE CENTER
Practice Address - State:MN
Practice Address - Zip Code:56057-1768
Practice Address - Country:US
Practice Address - Phone:507-357-2323
Practice Address - Fax:507-357-2370
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3075111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN501120000Medicaid
MN3C805SCOtherBLUE CROSS BLUE SHIELD OF MN
MN350004033Medicare PIN