=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952565434
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICHOLAS MICHAEL WELLS D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2008
-----------------------------------------------------
Last Update Date | 04/12/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1214 HANCOCK ST
-----------------------------------------------------
City | HOLDREGE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68949-1336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-995-9544
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 502 4TH AVE.
-----------------------------------------------------
City | HOLDREGE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-995-2110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1559
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------