Provider Demographics
NPI:1043783327
Name:SCHACKER, RYAN EVERETT
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:EVERETT
Last Name:SCHACKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 EDGEVIEW DR APT 6310
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-8098
Mailing Address - Country:US
Mailing Address - Phone:631-678-8714
Mailing Address - Fax:
Practice Address - Street 1:120 EDGEVIEW DR APT 6310
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-8098
Practice Address - Country:US
Practice Address - Phone:631-678-8714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician