Provider Demographics
NPI:1083749113
Name:SCHELLY, CHARLES ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ANDREW
Last Name:SCHELLY
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:PO BOX 1805
Mailing Address - Street 2:
Mailing Address - City:IDYLLWILD
Mailing Address - State:CA
Mailing Address - Zip Code:92549-1805
Mailing Address - Country:US
Mailing Address - Phone:951-659-4663
Mailing Address - Fax:
Practice Address - Street 1:54545 N. CIRCLE DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:IDYLLWILD
Practice Address - State:CA
Practice Address - Zip Code:92549-1805
Practice Address - Country:US
Practice Address - Phone:951-659-4663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U49735Medicare ID - Type Unspecified