Provider Demographics
NPI:1780664466
Name:WELLMAN, JOHN BRENT (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRENT
Last Name:WELLMAN
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 1:2531 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49331-8695
Mailing Address - Country:US
Mailing Address - Phone:616-897-8284
Mailing Address - Fax:616-897-6810
Practice Address - Street 1:2531 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-8695
Practice Address - Country:US
Practice Address - Phone:616-897-8284
Practice Address - Fax:616-897-6810
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJW002140111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOD15056Medicare ID - Type UnspecifiedMEDICARE