Provider Demographics
NPI:1104033323
Name:MARK WELLS DC PA
Entity Type:Organization
Organization Name:MARK WELLS DC PA
Other - Org Name:ADVANCED CHIROPRACTIC OF BELTSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-572-1655
Mailing Address - Street 1:11615 BELTSVILLE DR
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3145
Mailing Address - Country:US
Mailing Address - Phone:301-572-1655
Mailing Address - Fax:
Practice Address - Street 1:11615 BELTSVILLE DR
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3145
Practice Address - Country:US
Practice Address - Phone:301-572-1655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF085 0001OtherBCBS OF NATIONAL CAPITAL
MDKD46OtherBCBS OF MD
MDF085 0001OtherBCBS OF NATIONAL CAPITAL
MD434520Medicare UPIN
MD127242Medicare PIN