Provider Demographics
NPI:1760407811
Name:WELLS, RICHARD E JR (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:WELLS
Suffix:JR
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 1:9 CENTRE CT
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:VA
Mailing Address - Zip Code:22963-2329
Mailing Address - Country:US
Mailing Address - Phone:434-589-8005
Mailing Address - Fax:434-589-1401
Practice Address - Street 1:9 CENTRE CT
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:VA
Practice Address - Zip Code:22963-2329
Practice Address - Country:US
Practice Address - Phone:434-589-8005
Practice Address - Fax:434-589-1401
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556095111N00000X
SC3138111N00000X
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5897666OtherGHI
VA230221OtherSOUTHERN HEALTH
VA267037OtherANTHEM BC/BS
VA7973495OtherAETNA
CA2473475OtherCIGNA
VAU96420Medicare UPIN