Provider Demographics
NPI:1861444622
Name:WELLS, STEPHEN BOLES (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BOLES
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 1:2108 CAMDEN AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5672
Mailing Address - Country:US
Mailing Address - Phone:304-422-9600
Mailing Address - Fax:304-422-9603
Practice Address - Street 1:2108 CAMDEN AVE
Practice Address - Street 2:SUITE D
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5672
Practice Address - Country:US
Practice Address - Phone:304-422-9600
Practice Address - Fax:304-422-9603
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001722356OtherMSBCBS
WV0132314000Medicaid
WVWE0888133Medicare PIN
U80574Medicare UPIN