Provider Demographics
NPI:1679681712
Name:WELLS, LEIGHIA M (DC)
Entity type:Individual
Prefix:DR
First Name:LEIGHIA
Middle Name:M
Last Name:WELLS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8175 CREEKSIDE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-5370
Mailing Address - Country:US
Mailing Address - Phone:269-324-5000
Mailing Address - Fax:269-324-5822
Practice Address - Street 1:8175 CREEKSIDE DR STE 110
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-5370
Practice Address - Country:US
Practice Address - Phone:269-324-5000
Practice Address - Fax:269-324-5822
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008424111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950C901390OtherBLUE CROSS
MIOC91156OtherBLUE CROSS
MI950C901390OtherBLUE CROSS
MIOC91156OtherBLUE CROSS