Provider Demographics
NPI:1821165358
Name:WELLMAN, ROBERT JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JASON
Last Name:WELLMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:WELLMAN
Other - Middle Name:
Other - Last Name:CHIROPRACTIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:124 CHAPEL CROSSING ROAD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525
Mailing Address - Country:US
Mailing Address - Phone:912-554-2002
Mailing Address - Fax:912-554-2290
Practice Address - Street 1:124 CHAPEL CROSSING ROAD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525
Practice Address - Country:US
Practice Address - Phone:912-554-2002
Practice Address - Fax:912-554-2290
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV747111N00000X
GACHIR009519111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001722741OtherBCBS
WV9320261Medicare ID - Type Unspecified
WV001722741OtherBCBS