Provider Demographics
NPI:1962564211
Name:WELLS, KELLY J (DC, CSOM, DIPBBM)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:J
Last Name:WELLS
Suffix:
Gender:F
Credentials:DC, CSOM, DIPBBM
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:J
Other - Last Name:HIBLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:54B ROLLING OAKS RD
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-9337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2200
Practice Address - Country:US
Practice Address - Phone:630-614-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011002111NN0400X, 111NN1001X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN0400XChiropractic ProvidersChiropractorNeurology
No111NN1001XChiropractic ProvidersChiropractorNutrition