Healthcare Provider Details

I. General information

NPI: 1336134972
Provider Name (Legal Business Name): MICHAEL TROY SCHOMAKER D.C., B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19022 FREEPORT ST NW SUITE D
ELK RIVER MN
55330
US

IV. Provider business mailing address

19022 FREEPORT ST NW SUITE D
ELK RIVER MN
55330
US

V. Phone/Fax

Practice location:
  • Phone: 763-253-2000
  • Fax: 763-241-2191
Mailing address:
  • Phone: 763-253-2000
  • Fax: 763-241-2191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3405
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: