Provider Demographics
NPI:1063506665
Name:WELLY, LONALD A (DC)
Entity Type:Individual
Prefix:
First Name:LONALD
Middle Name:A
Last Name:WELLY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:LONALD
Other - Middle Name:
Other - Last Name:WELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17432 SMOKEY PT BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17432 SMOKEY PT BLVD
Practice Address - Street 2:STE 105
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223
Practice Address - Country:US
Practice Address - Phone:360-653-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1573111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT03067Medicare UPIN
WAG001200804Medicare ID - Type Unspecified