Healthcare Provider Details

I. General information

NPI: 1619016367
Provider Name (Legal Business Name): LAWRENCE EDWARD WELLS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6581 GRACELY DR
CINCINNATI OH
45233-1242
US

IV. Provider business mailing address

6581 GRACELY DR
CINCINNATI OH
45233-1242
US

V. Phone/Fax

Practice location:
  • Phone: 513-941-6650
  • Fax: 513-941-6652
Mailing address:
  • Phone: 513-941-6650
  • Fax: 513-941-6652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number3146
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: