Provider Demographics
NPI:1134281611
Name:WELLS, EVERETT HENRY JR (DC)
Entity Type:Individual
Prefix:DR
First Name:EVERETT
Middle Name:HENRY
Last Name:WELLS
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 S VOLUSIA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7026
Mailing Address - Country:US
Mailing Address - Phone:386-775-2100
Mailing Address - Fax:386-775-1452
Practice Address - Street 1:1251 S VOLUSIA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7026
Practice Address - Country:US
Practice Address - Phone:386-775-2100
Practice Address - Fax:386-775-1452
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0001491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL350055886OtherRAILROAD MEDICARE
FL380128400Medicaid
FL89663OtherPROVIDER NUMBER
FL610669300OtherDOL
FL350055886OtherRAILROAD MEDICARE
FL89663OtherPROVIDER NUMBER