Provider Demographics
NPI:1659619583
Name:WELLS, JACK ARLLEN III (DC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:ARLLEN
Last Name:WELLS
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:128 N MAIN ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-3210
Mailing Address - Country:US
Mailing Address - Phone:254-415-8985
Mailing Address - Fax:254-831-5068
Practice Address - Street 1:128 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-3210
Practice Address - Country:US
Practice Address - Phone:254-415-8985
Practice Address - Fax:254-831-5068
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12216111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12216OtherTEXAS BOARD OF CHIROPRACTIC