MEDICARE: DR. NATHAN TROY SCHULZ D.C.

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	3824	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	775S2SC	OTHER	MN	BCBS PIN NUMBER
2	P00260906	OTHER	MN	PALMETTO GBA PIN NUMBER
3	DD9286	OTHER	MN	PALMETTO GBA GROUP NUMBER

General Provider Information

NPI Number	:	1033266317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN TROY SCHULZ D.C.

Provider Business Mailing Address
First Line	:	925 S OAK ST
Second Line	:
City	:	LAKE CITY
State	:	MN
Zip	:	55041-1856
Country	:	US
Telephone Number	:	651-345-5615
Fax Number	:	651-345-4005

Provider Business Practice Location Address
First Line	:	925 S OAK ST
Second Line	:
City	:	LAKE CITY
State	:	MN
Zip	:	55041-1856
Country	:	US
Telephone Number	:	651-345-5615
Fax Number	:	651-345-4005

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	09/16/2014

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