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General NPI Number Information
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NPI Number | 1861747628
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Entity Type | Organization
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Legal Business Name | JEFFREY BRUCE WELLUM
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Dates
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Enumeration Date | 07/18/2012
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Last Update Date | 07/18/2012
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Provider Practice Location Address
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Address Line | 1602 ILLINOIS HIGHWAY 1
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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 | 218-826-8028
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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 | 217-826-8028
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Fax | 217-826-8195
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY BRUCE WELLUM
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Credential | D.C.
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Telephone | 217-826-8028
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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 | 038006155
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License Number State | IL
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