Provider Demographics
NPI:1467444356
Name:WELLS, RICHARD C (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:WELLS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000627A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCJ6150Medicare ID - Type UnspecifiedRD MDCR CORP PROVIDER #
IN150070Medicare ID - Type UnspecifiedCORP PROVIDER #
IN150070AMedicare ID - Type UnspecifiedINDIV PROVIDER #