Provider Demographics
NPI:1780128132
Name:SCHMIDT, BRODERICK (DC)
Entity type:Individual
Prefix:DR
First Name:BRODERICK
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 CENTER AVE W
Mailing Address - Street 2:SUITE B
Mailing Address - City:DILWORTH
Mailing Address - State:MN
Mailing Address - Zip Code:56529-1346
Mailing Address - Country:US
Mailing Address - Phone:218-236-1187
Mailing Address - Fax:218-236-8514
Practice Address - Street 1:1675 CENTER AVE W
Practice Address - Street 2:SUITE B
Practice Address - City:DILWORTH
Practice Address - State:MN
Practice Address - Zip Code:56529-1346
Practice Address - Country:US
Practice Address - Phone:218-236-1187
Practice Address - Fax:218-236-8514
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor