Individual
DR. RICKY LYNN PETHERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
430 BOYNE AVE, BOYNE CITY, MI 49712-1263
(231) 582-6581
(231) 582-6449
Mailing address
430 BOYNE AVE, BOYNE CITY, MI 49712-1263
(231) 582-6581
(231) 582-6449
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301002936
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2099227
—
MI
01
—
950A55010
BLUE CROSS/BLUE SHIELD
MI
Enumeration date
09/15/2006
Last updated
07/08/2007
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