Provider Demographics
NPI:1669406922
Name:WELLS, JENNIFER MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:WELLS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 6TH ST
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-1442
Mailing Address - Country:US
Mailing Address - Phone:951-427-1820
Mailing Address - Fax:951-427-1822
Practice Address - Street 1:911 6TH ST
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-1442
Practice Address - Country:US
Practice Address - Phone:951-427-1820
Practice Address - Fax:951-427-1822
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU73110Medicare UPIN