Provider Demographics
NPI:1235282328
Name:WELLBROOK, THOMAS WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WAYNE
Last Name:WELLBROOK
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 1:21471 FOOTHILL BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-2170
Mailing Address - Country:US
Mailing Address - Phone:510-582-7418
Mailing Address - Fax:510-582-7244
Practice Address - Street 1:21471 FOOTHILL BLVD STE D
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-2170
Practice Address - Country:US
Practice Address - Phone:510-582-7418
Practice Address - Fax:510-582-7244
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22208111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU35101Medicare UPIN