Healthcare Provider Details

I. General information

NPI: 1992706592
Provider Name (Legal Business Name): MARY B SCHULTZ D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N MAIN ST
IOLA WI
54945-9492
US

IV. Provider business mailing address

N9320 STATE ROAD 49
IOLA WI
54945-9424
US

V. Phone/Fax

Practice location:
  • Phone: 715-445-4002
  • Fax: 715-445-4390
Mailing address:
  • Phone: 715-445-4777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2569
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: