Provider Demographics
NPI:1780622191
Name:SCHMIDT CHIROPRACTIC CLINIC, INC.
Entity type:Organization
Organization Name:SCHMIDT CHIROPRACTIC CLINIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:B
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-251-1550
Mailing Address - Street 1:102 2ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-4104
Mailing Address - Country:US
Mailing Address - Phone:701-251-1550
Mailing Address - Fax:701-952-1504
Practice Address - Street 1:102 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-4104
Practice Address - Country:US
Practice Address - Phone:701-251-1550
Practice Address - Fax:701-952-1504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2011-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND011826Medicaid
MN26782SCOtherBLUE SHIELD
ND629001OtherBLUE SHIELD
ND15500Medicaid
MN26782SCOtherBLUE SHIELD
NDN715788Medicare UPIN