Provider Demographics
NPI:1942379508
Name:WELLS, CHAD (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:
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 1:1116 STATE ROUTE 434
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-1758
Mailing Address - Country:US
Mailing Address - Phone:607-687-8787
Mailing Address - Fax:
Practice Address - Street 1:1116 STATE ROUTE 434
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-1758
Practice Address - Country:US
Practice Address - Phone:607-687-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010754111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA0834Medicare UPIN