Healthcare Provider Details

I. General information

NPI: 1083749113
Provider Name (Legal Business Name): CHARLES ANDREW SCHELLY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54545 N. CIRCLE DRIVE SUITE 2
IDYLLWILD CA
92549-1805
US

IV. Provider business mailing address

PO BOX 1805
IDYLLWILD CA
92549-1805
US

V. Phone/Fax

Practice location:
  • Phone: 951-659-4663
  • Fax:
Mailing address:
  • Phone: 951-659-4663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC23106
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: