MEDICARE: CLOTILDE JEANNE SCHMIDT DC

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	CH00002963	WA

General Provider Information

NPI Number	:	1023175759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLOTILDE JEANNE SCHMIDT DC

Provider Business Mailing Address
First Line	:	310 CLEVELAND AVE SE
Second Line	:
City	:	TUMWATER
State	:	WA
Zip	:	98501-3310
Country	:	US
Telephone Number	:	360-943-6015
Fax Number	:	360-943-2807

Provider Business Practice Location Address
First Line	:	310 CLEVELAND AVE SE
Second Line	:
City	:	TUMWATER
State	:	WA
Zip	:	98501-3310
Country	:	US
Telephone Number	:	360-943-6015
Fax Number	:	360-943-2807

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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