Provider Demographics
NPI:1144238353
Name:SCHMIDT, MATTHEW EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:EDWARD
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7456 JACK PINE CT
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8139
Mailing Address - Country:US
Mailing Address - Phone:309-369-0486
Mailing Address - Fax:309-284-0385
Practice Address - Street 1:7456 JACK PINE CT
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8139
Practice Address - Country:US
Practice Address - Phone:309-369-0486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003546A111N00000X
IL038008358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL0100OtherJOHN DEERE HEALTH
IL071862OtherHEALTH ALLIANCE
IL5782014OtherBLUE CROSS BLUE SHIELD
IL5782014OtherBLUE CROSS BLUE SHIELD