Provider Demographics
NPI:1619475084
Name:SCHMIDT, CARISSA LEIGH (DC)
Entity type:Individual
Prefix:MRS
First Name:CARISSA
Middle Name:LEIGH
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:CARISSA
Other - Middle Name:LEIGH
Other - Last Name:BRACKELSBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3709 E 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034
Mailing Address - Country:US
Mailing Address - Phone:405-888-3534
Mailing Address - Fax:405-562-6636
Practice Address - Street 1:3709 E 2ND STREET
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034
Practice Address - Country:US
Practice Address - Phone:405-888-3534
Practice Address - Fax:405-562-6636
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty