Provider Demographics
NPI:1003899030
Name:WELLS, PAMELA F (DC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:F
Last Name:WELLS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 E REMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1941
Mailing Address - Country:US
Mailing Address - Phone:408-737-0330
Mailing Address - Fax:408-737-0692
Practice Address - Street 1:685 E REMINGTON DR
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1941
Practice Address - Country:US
Practice Address - Phone:408-737-0330
Practice Address - Fax:408-737-0692
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 17414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770194764OtherTAX ID
CADC0174140Medicare ID - Type UnspecifiedMEDICARE ID
CAU30974Medicare UPIN