Provider Demographics
NPI:1679612659
Name:WELLS, DAVID ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROBERT
Last Name:WELLS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WATER ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:17327-1011
Mailing Address - Country:US
Mailing Address - Phone:717-235-8855
Mailing Address - Fax:717-235-8850
Practice Address - Street 1:40 WATER ST
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:PA
Practice Address - Zip Code:17327-1011
Practice Address - Country:US
Practice Address - Phone:717-235-8855
Practice Address - Fax:717-235-8850
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007378L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01743950 01Medicaid
PASO1351319OtherHIGHMARK BS
PAU74537Medicare UPIN
PA025908Medicare ID - Type Unspecified