Provider Demographics
NPI:1801121678
Name:WELLS, MICHAEL (DC, LAC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:WELLS
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5363 BALBOA BLVD STE 234
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2825
Mailing Address - Country:US
Mailing Address - Phone:818-788-4220
Mailing Address - Fax:818-789-6077
Practice Address - Street 1:5363 BALBOA BLVD STE 234
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2825
Practice Address - Country:US
Practice Address - Phone:818-788-4220
Practice Address - Fax:818-789-6077
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31411111N00000X
CAAC16721171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist