Provider Demographics
NPI:1699709345
Name:FARR, KENNETH L (D C)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:L
Last Name:FARR
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 E BROADWAY RD #104
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206
Mailing Address - Country:US
Mailing Address - Phone:408-396-6000
Mailing Address - Fax:480-396-9437
Practice Address - Street 1:4455 E BROADWAY RD #104
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206
Practice Address - Country:US
Practice Address - Phone:408-396-6000
Practice Address - Fax:480-396-9437
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5281111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0943510OtherBCBS
U47347Medicare UPIN
AZ262926Medicare ID - Type Unspecified