Healthcare Provider Details

I. General information

NPI: 1679612659
Provider Name (Legal Business Name): DAVID ROBERT WELLS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

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

40 WATER ST
GLEN ROCK PA
17327-1011
US

IV. Provider business mailing address

40 WATER ST
GLEN ROCK PA
17327-1011
US

V. Phone/Fax

Practice location:
  • Phone: 717-235-8855
  • Fax: 717-235-8850
Mailing address:
  • Phone: 717-235-8855
  • Fax: 717-235-8850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC007378L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: