Provider Demographics
NPI:1952407702
Name:SCHMIDT, OTTO J (DC)
Entity Type:Individual
Prefix:DR
First Name:OTTO
Middle Name:J
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 1:7664 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-6746
Mailing Address - Country:US
Mailing Address - Phone:216-520-6880
Mailing Address - Fax:216-520-6885
Practice Address - Street 1:7664 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-6746
Practice Address - Country:US
Practice Address - Phone:216-520-6880
Practice Address - Fax:216-520-6885
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1815111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0710863Medicare PIN