Provider Demographics
NPI:1629235155
Name:JOHNSON SCHMALZ, JENNIFER S (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:S
Last Name:JOHNSON SCHMALZ
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 1:1755 17TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-3372
Mailing Address - Country:US
Mailing Address - Phone:952-445-5250
Mailing Address - Fax:952-445-5350
Practice Address - Street 1:1755 17TH AVE E
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3372
Practice Address - Country:US
Practice Address - Phone:952-445-5250
Practice Address - Fax:952-445-5350
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350004128Medicare UPIN