Provider Demographics
NPI:1225416324
Name:WELLS, BROCK (DC)
Entity Type:Individual
Prefix:DR
First Name:BROCK
Middle Name:
Last Name:WELLS
Suffix:
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 1:1435 E 30TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-1235
Mailing Address - Country:US
Mailing Address - Phone:620-860-2174
Mailing Address - Fax:620-921-3209
Practice Address - Street 1:1435 E 30TH AVE STE B
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1235
Practice Address - Country:US
Practice Address - Phone:620-860-2174
Practice Address - Fax:620-921-3209
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05706111N00000X
KS0105706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty