Provider Demographics
NPI:1003162793
Name:WELLY CHIROPRACTIC PS
Entity Type:Organization
Organization Name:WELLY CHIROPRACTIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:WELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-653-2222
Mailing Address - Street 1:17432 SMOKEY POINT BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8784
Mailing Address - Country:US
Mailing Address - Phone:360-653-2222
Mailing Address - Fax:360-653-5730
Practice Address - Street 1:17432 SMOKEY POINT BLVD STE 105
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8784
Practice Address - Country:US
Practice Address - Phone:360-653-2222
Practice Address - Fax:360-653-5730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty