Healthcare Provider Details

I. General information

NPI: 1790999563
Provider Name (Legal Business Name): TRICIA ANNMARIE E WELLS D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 W 95TH ST
CHICAGO IL
60643-1246
US

IV. Provider business mailing address

428 INDIANA ST
PARK FOREST IL
60466-1162
US

V. Phone/Fax

Practice location:
  • Phone: 773-239-1400
  • Fax: 773-239-0400
Mailing address:
  • Phone: 708-283-1534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: