Provider Demographics
NPI:1780812131
Name:SCHMIDT, DUSTIN EUGENE (DC)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:EUGENE
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:PO BOX 3033
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-3033
Mailing Address - Country:US
Mailing Address - Phone:405-509-7017
Mailing Address - Fax:
Practice Address - Street 1:6516 N OLIE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7226
Practice Address - Country:US
Practice Address - Phone:405-509-7017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3927111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor