Provider Demographics
NPI:1205233590
Name:SCHMIDT, KORT (L AC MAOM)
Entity type:Individual
Prefix:
First Name:KORT
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:L AC MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 12TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2811
Mailing Address - Country:US
Mailing Address - Phone:503-952-6781
Mailing Address - Fax:503-967-7591
Practice Address - Street 1:1118 12TH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2811
Practice Address - Country:US
Practice Address - Phone:503-952-6781
Practice Address - Fax:503-967-7591
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC170186171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist