Provider Demographics
NPI:1932752193
Name:SCHULTZ, CHARLOTTE KEATING (DIPL OM, MSTCM)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:KEATING
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:DIPL OM, MSTCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716B STODDARD ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-2502
Mailing Address - Country:US
Mailing Address - Phone:415-846-9530
Mailing Address - Fax:
Practice Address - Street 1:2145 SOUTH AVE W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6503
Practice Address - Country:US
Practice Address - Phone:406-646-6395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-ACU-LIC-77381171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
171030OtherNCCAOM
MTMED-ACU-LIC-77381OtherMEDICAL LICENSING - STATE OF MONTANA