Provider Demographics
NPI:1205108966
Name:WELLS, BRYAN MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:MICHAEL
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 1:2601 20TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6632
Mailing Address - Country:US
Mailing Address - Phone:772-299-4649
Mailing Address - Fax:772-299-4651
Practice Address - Street 1:2601 20TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6632
Practice Address - Country:US
Practice Address - Phone:772-299-4649
Practice Address - Fax:772-299-4651
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor