Provider Demographics
NPI:1619016367
Name:WELLS, LAWRENCE EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:EDWARD
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 1:6581 GRACELY DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45233-1242
Mailing Address - Country:US
Mailing Address - Phone:513-941-6650
Mailing Address - Fax:513-941-6652
Practice Address - Street 1:6581 GRACELY DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45233-1242
Practice Address - Country:US
Practice Address - Phone:513-941-6650
Practice Address - Fax:513-941-6652
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3146111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation