Provider Demographics
NPI:1740329002
Name:WELLS, WILLIAM A (DC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
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 1:6130 HWY 116
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95436-9397
Mailing Address - Country:US
Mailing Address - Phone:707-887-1206
Mailing Address - Fax:707-887-7727
Practice Address - Street 1:6130 HWY 116
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:CA
Practice Address - Zip Code:95436-9397
Practice Address - Country:US
Practice Address - Phone:707-887-1206
Practice Address - Fax:707-887-7727
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 10970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor