MEDICARE: DR. JEFFREY B WELLUM D.C.

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	038-006155	IL

General Provider Information

NPI Number	:	1467451559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY B WELLUM D.C.

Provider Business Mailing Address
First Line	:	PO BOX 303
Second Line	:
City	:	MARSHALL
State	:	IL
Zip	:	62441-0303
Country	:	US
Telephone Number	:	217-826-8028
Fax Number	:	217-826-8195

Provider Business Practice Location Address
First Line	:	1602 ILLINOIS HIGHWAY 1
Second Line	:
City	:	MARSHALL
State	:	IL
Zip	:	62441-3108
Country	:	US
Telephone Number	:	217-826-8028
Fax Number	:	217-826-8195

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	11/17/2014

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