Provider Demographics
NPI:1104340785
Name:WELLS, CHRIS
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:WELLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N GENEVA RD STE B
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-1214
Mailing Address - Country:US
Mailing Address - Phone:801-871-9321
Mailing Address - Fax:844-855-5134
Practice Address - Street 1:400 N GENEVA RD STE B
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-1214
Practice Address - Country:US
Practice Address - Phone:801-871-9321
Practice Address - Fax:844-855-5134
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10418063-1714332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies