Provider Demographics
NPI:1336275379
Name:SCHULTZ, GINA RENEE (DC)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:RENEE
Last Name:SCHULTZ
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 56
Mailing Address - Street 2:320 S MAIN ST.
Mailing Address - City:BLANCHARDVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53516-0056
Mailing Address - Country:US
Mailing Address - Phone:608-523-4612
Mailing Address - Fax:608-523-4614
Practice Address - Street 1:320 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLANCHARDVILLE
Practice Address - State:WI
Practice Address - Zip Code:53516-0056
Practice Address - Country:US
Practice Address - Phone:608-523-4612
Practice Address - Fax:608-523-4614
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3562-012111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU76053Medicare UPIN
WI35537Medicare PIN