Provider Demographics
NPI:1891267076
Name:SCHMIDT, GERARD (DC)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:
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 1:21 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-2010
Mailing Address - Country:US
Mailing Address - Phone:570-764-1694
Mailing Address - Fax:
Practice Address - Street 1:3130 MEMORIAL HWY # 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-9228
Practice Address - Country:US
Practice Address - Phone:570-675-3833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003496L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor