Provider Demographics
NPI:1609965953
Name:WELLER, ALAN W (DC)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:W
Last Name:WELLER
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 1:715 LAKE ST.
Mailing Address - Street 2:STE 271
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301
Mailing Address - Country:US
Mailing Address - Phone:708-848-2730
Mailing Address - Fax:708-848-2739
Practice Address - Street 1:715 LAKE ST.
Practice Address - Street 2:STE 271
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301
Practice Address - Country:US
Practice Address - Phone:708-848-2730
Practice Address - Fax:708-848-2739
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-004298111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
36-3407882OtherFEIN
IL10452Medicare UPIN
662860Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER