Healthcare Provider Details

I. General information

NPI: 1407229552
Provider Name (Legal Business Name): SHANE WELLS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 MESA RD STE 150
COLORADO SPRINGS CO
80904-1050
US

IV. Provider business mailing address

3310 MESA RD STE 150
COLORADO SPRINGS CO
80904-1050
US

V. Phone/Fax

Practice location:
  • Phone: 719-428-2202
  • Fax:
Mailing address:
  • Phone: 719-428-2202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHR0006623
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: