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General NPI Number Information
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NPI Number | 1285851188
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Entity Type | Organization
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Legal Business Name | WELLUM CHIROPRACTIC CENTER INC
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 06/14/2010
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Provider Practice Location Address
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Address Line | 1602 ILLINOIS HWY 1
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City | MARSHALL
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State | IL
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Zip | 62441
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Country | US
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Telephone | 217-826-2422
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Fax | 217-826-8195
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Provider Business Mailing Address
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Address Line | PO BOX 303
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City | MARSHALL
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State | IL
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Zip | 62441-0303
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Country | US
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Telephone | 217-826-2422
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Fax | 217-826-8195
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. JEFFREY BRUCE WELLUM
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Credential | D.C.
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Telephone | 217-826-2422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 060-001349
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License Number State | IL
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