Provider Demographics
NPI:1902969199
Name:SCHELTER, RICKY OTTO (DC)
Entity Type:Individual
Prefix:MR
First Name:RICKY
Middle Name:OTTO
Last Name:SCHELTER
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 1:3058 N STATE RD UNIT D
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423
Mailing Address - Country:US
Mailing Address - Phone:810-658-3383
Mailing Address - Fax:810-653-4425
Practice Address - Street 1:3058 N STATE RD UNIT D
Practice Address - Street 2:DAVISON CHIROPRACTIC
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423
Practice Address - Country:US
Practice Address - Phone:810-658-3383
Practice Address - Fax:810-653-4425
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI005260111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOB51216OtherBLUE CROSS
MI187201714Medicaid
RS005260Medicare UPIN
MI0B551406952Medicare ID - Type Unspecified