Provider Demographics
NPI:1689715104
Name:WELLS, JOHN MYRON (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MYRON
Last Name:WELLS
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 1:9550 BLACK MOUNTAIN RD
Mailing Address - Street 2:STE E
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4577
Mailing Address - Country:US
Mailing Address - Phone:858-549-5800
Mailing Address - Fax:858-578-0722
Practice Address - Street 1:9550 BLACK MOUNTAIN RD
Practice Address - Street 2:STE E
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4577
Practice Address - Country:US
Practice Address - Phone:858-549-5800
Practice Address - Fax:858-578-0722
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor