Provider Demographics
NPI:1063696540
Name:WELLS CHIROPRACTIC CLINIC INC
Entity type:Organization
Organization Name:WELLS CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MALWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-526-5656
Mailing Address - Street 1:105 N GROVE ST
Mailing Address - Street 2:
Mailing Address - City:BLUE EARTH
Mailing Address - State:MN
Mailing Address - Zip Code:56013-2407
Mailing Address - Country:US
Mailing Address - Phone:507-526-5656
Mailing Address - Fax:507-526-5757
Practice Address - Street 1:105 N GROVE ST
Practice Address - Street 2:
Practice Address - City:BLUE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56013-2407
Practice Address - Country:US
Practice Address - Phone:507-526-5656
Practice Address - Fax:507-526-5757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN157L4WEOtherBC/BS OF MINNESOTA
MNDC5746OtherRAILROAD MEDICARE
MN779458400Medicaid
MN779458400Medicaid