Healthcare Provider Details

I. General information

NPI: 1619971405
Provider Name (Legal Business Name): KRISTAL SCHMIDT DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTAL KAY VANCE DC

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 09/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W LAKEWAY RD STE 200
GILLETTE WY
82718-6341
US

IV. Provider business mailing address

201 W LAKEWAY RD STE 200
GILLETTE WY
82718-6341
US

V. Phone/Fax

Practice location:
  • Phone: 307-682-7885
  • Fax: 307-682-2153
Mailing address:
  • Phone: 307-682-7885
  • Fax: 307-682-2153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number674
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: