Provider Demographics
NPI:1922098078
Name:SCHMIDT, KRISTIE M (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:M
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:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:MN
Mailing Address - Zip Code:55951-0547
Mailing Address - Country:US
Mailing Address - Phone:507-324-9355
Mailing Address - Fax:
Practice Address - Street 1:111 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:MN
Practice Address - Zip Code:55951-6709
Practice Address - Country:US
Practice Address - Phone:507-324-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4480111N00000X
IA06555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN680278800Medicaid
MN350003124Medicare ID - Type Unspecified
MN680278800Medicaid