Provider Demographics
NPI:1295898930
Name:WELLS, BRENT WADE
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:WADE
Last Name:WELLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8840 OLD SEWARD HWY STE E
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2000
Mailing Address - Country:US
Mailing Address - Phone:907-346-5255
Mailing Address - Fax:907-346-5256
Practice Address - Street 1:8840 OLD SEWARD HWY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2020
Practice Address - Country:US
Practice Address - Phone:907-346-5255
Practice Address - Fax:907-346-5256
Is Sole Proprietor?:No
Enumeration Date:2006-12-17
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCHIC334111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor