Provider Demographics
NPI:1417077876
Name:WELLS CHIROPRACTIC ASSOCIATES, PC
Entity Type:Organization
Organization Name:WELLS CHIROPRACTIC ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-563-8841
Mailing Address - Street 1:265 HALE DR
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-3803
Mailing Address - Country:US
Mailing Address - Phone:260-563-8841
Mailing Address - Fax:260-563-8843
Practice Address - Street 1:265 HALE DR
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-3803
Practice Address - Country:US
Practice Address - Phone:260-563-8841
Practice Address - Fax:260-563-8843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN51000253A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCJ6150Medicare ID - Type UnspecifiedTRAVELER'S MEDICARE GROUP
IN150070Medicare ID - Type UnspecifiedGROUP #
IN000000108648Medicare UPIN