Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC8193 | TX |
NPI | 1003971086 |
---|---|
Provider Name | Jeffry Chad Welty |
First Address | Amarillo, TX 79121-1400 |
Second Address | Amarillo, TX 79121-1400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0078255 | BLUE LINK (01) | TX |
609191 | BLUE CROSS (01) | TX |
U73171 | (02) | TX |