Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038011002 | IL |
N | 111NN0400X | Neurology | 038011002 | IL |
N | 111NN1001X | Nutrition | 038011002 | IL |
NPI | 1962564211 |
---|---|
Provider Name | Dr. Kelly J Wells |
First Address | Sugar Grove, IL 60554-9337 |
Second Address | St Charles, IL 60174-2200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 18/01/2021 |