Provider Demographics
NPI:1538358734
Name:FARRIS, RICHARD A (DC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:FARRIS
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:PO BOX 1204
Mailing Address - Street 2:
Mailing Address - City:ALTO
Mailing Address - State:NM
Mailing Address - Zip Code:88312-1204
Mailing Address - Country:US
Mailing Address - Phone:575-336-9140
Mailing Address - Fax:
Practice Address - Street 1:471 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NM
Practice Address - Zip Code:88318
Practice Address - Country:US
Practice Address - Phone:575-849-1561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor