Provider Demographics
NPI:1467451559
Name:WELLUM, JEFFREY B (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:B
Last Name:WELLUM
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:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:IL
Mailing Address - Zip Code:62441-0303
Mailing Address - Country:US
Mailing Address - Phone:217-826-8028
Mailing Address - Fax:217-826-8195
Practice Address - Street 1:1602 ILLINOIS HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:IL
Practice Address - Zip Code:62441-3108
Practice Address - Country:US
Practice Address - Phone:217-826-8028
Practice Address - Fax:217-826-8195
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006155111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT39138Medicare UPIN
IL789000Medicare PIN