Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2020035077 | MO |
N | 111NS0005X | Chiropractic Sports Physician | 2020035077 | MO |
NPI | 1164021408 |
---|---|
Provider Name | Jacob Schmitz |
First Address | Saint Charles, MO 63304-1029 |
Second Address | Saint Charles, MO 63304-1029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2020 |
Last Update Date | 21/01/2021 |