Provider Demographics
NPI:1598911604
Name:WELLMAN, KENDRA A (DC)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:A
Last Name:WELLMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 E GREENWAY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4805
Mailing Address - Country:US
Mailing Address - Phone:602-867-1444
Mailing Address - Fax:602-867-7255
Practice Address - Street 1:4646 E GREENWAY RD STE 104
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4805
Practice Address - Country:US
Practice Address - Phone:602-867-1444
Practice Address - Fax:602-867-7255
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-09
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ860951102111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician