Provider Demographics
NPI:1487726865
Name:WELLS, MISTY DAWN (DC)
Entity type:Individual
Prefix:DR
First Name:MISTY
Middle Name:DAWN
Last Name:WELLS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 NE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:SD
Mailing Address - Zip Code:57042-2322
Mailing Address - Country:US
Mailing Address - Phone:605-256-4752
Mailing Address - Fax:605-256-4752
Practice Address - Street 1:414 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:SD
Practice Address - Zip Code:57042-2322
Practice Address - Country:US
Practice Address - Phone:605-256-4752
Practice Address - Fax:605-256-4752
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1065111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD248610OtherMIDLANDS CHOICE
SD13737OtherAVERA
SD4994402OtherWELLMARK, BLUE CROSS
SDC1065OtherDAKOTACARE
SD248610OtherMIDLANDS CHOICE