Provider Demographics
NPI:1952359556
Name:WELLS, MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
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 1:1259 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:PA
Mailing Address - Zip Code:15431-2305
Mailing Address - Country:US
Mailing Address - Phone:724-626-0620
Mailing Address - Fax:724-626-0621
Practice Address - Street 1:1259 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:PA
Practice Address - Zip Code:15431-2305
Practice Address - Country:US
Practice Address - Phone:724-626-0620
Practice Address - Fax:724-626-0621
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009037111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019639440002Medicaid
PA0019639440002Medicaid
PA071846N5RMedicare ID - Type UnspecifiedDR. WELLS ID
PA0019639440002Medicaid
PAU96348Medicare UPIN