Provider Demographics
NPI:1336105915
Name:WELLS, BRIAN I (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:I
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 1:6608 AMELIA AVE
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004
Mailing Address - Country:US
Mailing Address - Phone:440-992-6022
Mailing Address - Fax:
Practice Address - Street 1:1956 W PROSPECT RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6424
Practice Address - Country:US
Practice Address - Phone:440-992-0160
Practice Address - Fax:440-998-0121
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000481233OtherANTHEM BLUE CROSS/BLUE SH
4334935OtherAETNA
OH000000481233OtherANTHEM BLUE CROSS/BLUE SH
WE0535732Medicare ID - Type Unspecified