Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC29738 | CA |
NPI | 1255456505 |
---|---|
Provider Name | Dr. Chad Michael Wells |
First Address | San Diego, CA 92121-3021 |
Second Address | San Diego, CA 92121-3021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |