Provider Demographics
NPI:1245367861
Name:SCHMITZ CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:SCHMITZ CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:SCHMITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-935-5553
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-0097
Mailing Address - Country:US
Mailing Address - Phone:608-935-5553
Mailing Address - Fax:608-935-5688
Practice Address - Street 1:103 W LEFFLER ST
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1175
Practice Address - Country:US
Practice Address - Phone:608-935-5553
Practice Address - Fax:608-935-5688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38867000Medicaid
WI38867000Medicaid