Provider Demographics
NPI:1881782761
Name:SCHMIDT, PHILIP B (DC)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:B
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 1:389 N MAIN ST
Mailing Address - Street 2:STE C
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-2716
Mailing Address - Country:US
Mailing Address - Phone:760-873-7178
Mailing Address - Fax:760-873-7697
Practice Address - Street 1:389 N MAIN ST
Practice Address - Street 2:STE C
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-2716
Practice Address - Country:US
Practice Address - Phone:760-873-7178
Practice Address - Fax:760-873-7697
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 24214111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA900190034OtherBLUE CROSS
CADC0242140OtherBLUE SHIELD
CADC0242140OtherMEDI/CAL
CADC0242140OtherMEDI/CAL
CADC0242140Medicare ID - Type UnspecifiedMEDICARE