MEDICARE: DR. RICHARD C WELLS DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	08000627A	IN

General Provider Information

NPI Number	:	1467444356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD C WELLS DC

Provider Business Mailing Address
First Line	:	265 HALE DR
Second Line	:
City	:	WABASH
State	:	IN
Zip	:	46992-3803
Country	:	US
Telephone Number	:	260-563-8841
Fax Number	:	260-563-8843

Provider Business Practice Location Address
First Line	:	265 HALE DR
Second Line	:
City	:	WABASH
State	:	IN
Zip	:	46992-3803
Country	:	US
Telephone Number	:	260-563-8841
Fax Number	:	260-563-8843

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	07/09/2007

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