Provider Demographics
NPI:1922124346
Name:WELLS, MARK STEVEN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
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 1:11615 BELTSVILLE DR
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3145
Mailing Address - Country:US
Mailing Address - Phone:301-572-1655
Mailing Address - Fax:301-572-1656
Practice Address - Street 1:11615 BELTSVILLE DR
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3145
Practice Address - Country:US
Practice Address - Phone:301-572-1655
Practice Address - Fax:301-572-1656
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKD46OtherCAREFIRST MD
MDF085 0001OtherCAREFIRST NCA
522070500OtherFEIN
MDF085 0001OtherCAREFIRST NCA
MDKD46OtherCAREFIRST MD