Healthcare Provider Details

I. General information

NPI: 1760407811
Provider Name (Legal Business Name): RICHARD E. WELLS JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CENTRE CT
PALMYRA VA
22963-2329
US

IV. Provider business mailing address

9 CENTRE CT
PALMYRA VA
22963-2329
US

V. Phone/Fax

Practice location:
  • Phone: 434-589-8005
  • Fax: 434-589-1401
Mailing address:
  • Phone: 434-589-8005
  • Fax: 434-589-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556095
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3138
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: