Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC 17414 | CA |
NPI | 1003899030 |
---|---|
Provider Name | Pamela F Wells |
First Address | Sunnyvale, CA 94087-1941 |
Second Address | Sunnyvale, CA 94087-1941 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 23/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
770194764 | TAX ID (01) | CA |
U30974 | (02) | CA |