Provider Demographics
NPI:1265623961
Name:SCHMIDT CHIROPRACTIC CENTER PS INC
Entity type:Organization
Organization Name:SCHMIDT CHIROPRACTIC CENTER PS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-943-6015
Mailing Address - Street 1:310 CLEVELAND AVE SE
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3310
Mailing Address - Country:US
Mailing Address - Phone:360-943-6015
Mailing Address - Fax:360-943-2807
Practice Address - Street 1:310 CLEVELAND AVE SE
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-3310
Practice Address - Country:US
Practice Address - Phone:360-943-6015
Practice Address - Fax:360-943-2807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1023175759OtherDR C J SCHMIDT INDIVIDUAL
WA1689730889OtherDR M R SCHMIDT INDIVIDUAL