MEDICARE: ELIZABETH A 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

General Provider Information

NPI Number	:	1821558750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZABETH A WELLS DC

Provider Business Mailing Address
First Line	:	6134 CAMINO VERDE DR STE H
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95119-1431
Country	:	US
Telephone Number	:	408-334-4742
Fax Number	:

Provider Business Practice Location Address
First Line	:	6134 CAMINO VERDE DR STE H
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95119-1431
Country	:	US
Telephone Number	:	408-334-4742
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ELIZABETH A WELLS
Credential	:	DC
Telephone Number	:	408-660-6727

Provider Enumeration Date	:	03/25/2019
Last Update Date	:	03/25/2019

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