Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | S43211666069 | AL |
NPI | 1043604978 |
---|---|
Provider Name | Dr. Cory Schultz |
First Address | Peru, IL 61354-1523 |
Second Address | Peru, IL 61354-1523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2015 |
Last Update Date | 28/03/2015 |