Provider Demographics
NPI:1255471710
Name:WELLMAN CHIROPRACTIC
Entity Type:Organization
Organization Name:WELLMAN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:WELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-429-4950
Mailing Address - Street 1:4614 WAVERLY RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-1039
Mailing Address - Country:US
Mailing Address - Phone:304-429-4950
Mailing Address - Fax:304-429-1060
Practice Address - Street 1:4614 WAVERLY RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-1039
Practice Address - Country:US
Practice Address - Phone:304-429-4950
Practice Address - Fax:304-429-1060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1821165358OtherROBERT WELLMAN
WV001722741OtherBCBS
WVU85407Medicare UPIN
WV9320261Medicare ID - Type Unspecified