MEDICARE: JEREMY JAMES SCHULTZ D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1179	SD

General Provider Information

NPI Number	:	1952610685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY JAMES SCHULTZ D.C.

Provider Business Mailing Address
First Line	:	1919 W 57TH ST STE 103
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-2711
Country	:	US
Telephone Number	:	605-362-1225
Fax Number	:	605-362-9525

Provider Business Practice Location Address
First Line	:	1919 W 57TH ST STE 103
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-2711
Country	:	US
Telephone Number	:	605-362-1225
Fax Number	:	605-362-9525

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	09/29/2010

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