Healthcare Provider Details

I. General information

NPI: 1962564211
Provider Name (Legal Business Name): KELLY J WELLS D.C., CSOM, DIPBBM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY J HIBLER D.C.

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E MAIN ST STE B
ST CHARLES IL
60174-2200
US

IV. Provider business mailing address

54B ROLLING OAKS RD
SUGAR GROVE IL
60554-9337
US

V. Phone/Fax

Practice location:
  • Phone: 630-614-1700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038011002
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number038011002
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number038011002
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: