Ricky Lynn Pethers, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2301002936 Issued in MI

Practice address

430 Boyne Ave
Boyne City, MI 49712-1263

Phone

(231) 582-6581

Fax

(231) 582-6449

NPI assigned

Sep 15, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Chiropractic

Education

National College of Chiropractic, 1978

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1982700456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 BOYNE AVE",
            "city": "BOYNE CITY",
            "state": "MI",
            "postal_code": "497121263",
            "telephone_number": "231-582-6581",
            "fax_number": "231-582-6449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 BOYNE AVE",
            "city": "BOYNE CITY",
            "state": "MI",
            "postal_code": "497121263",
            "telephone_number": "231-582-6581",
            "fax_number": "231-582-6449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETHERS",
        "first_name": "RICKY",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301002936",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2099227",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "950A55010",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Boyne City, MI
• Providers in Boyne City, MI by specialty
• Chiropractor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.