Provider Demographics
NPI:1396956157
Name:WELLS CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:WELLS CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:W
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-226-8450
Mailing Address - Street 1:314 ALAMANCE RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5528
Mailing Address - Country:US
Mailing Address - Phone:336-226-8450
Mailing Address - Fax:336-229-5298
Practice Address - Street 1:314 ALAMANCE RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5528
Practice Address - Country:US
Practice Address - Phone:336-226-8450
Practice Address - Fax:336-229-5298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2633111N00000X
NC2640111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89014R9Medicaid
NC604538OtherUHC
NC0835FOtherBCBS
NC2453293Medicare PIN
NC0835FOtherBCBS