Provider Demographics
NPI:1740653732
Name:WELLS CHIROPRACTIC INC
Entity type:Organization
Organization Name:WELLS CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:TOBIJAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-505-0057
Mailing Address - Street 1:1608 10TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244-1405
Mailing Address - Country:US
Mailing Address - Phone:309-755-0323
Mailing Address - Fax:
Practice Address - Street 1:1608 10TH ST
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-1405
Practice Address - Country:US
Practice Address - Phone:309-755-0323
Practice Address - Fax:309-755-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty