Healthcare Provider Details

I. General information

NPI: 1336275379
Provider Name (Legal Business Name): GINA RENEE SCHULTZ D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S MAIN ST
BLANCHARDVILLE WI
53516-0056
US

IV. Provider business mailing address

PO BOX 56 320 S MAIN ST.
BLANCHARDVILLE WI
53516-0056
US

V. Phone/Fax

Practice location:
  • Phone: 608-523-4612
  • Fax: 608-523-4614
Mailing address:
  • Phone: 608-523-4612
  • Fax: 608-523-4614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number3562-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: