Provider Demographics
NPI:1841329026
Name:FARRELL CHIROPRACTIC CENTER, INC.
Entity type:Organization
Organization Name:FARRELL CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:802-899-9991
Mailing Address - Street 1:213E VT ROUTE 15
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465-9639
Mailing Address - Country:US
Mailing Address - Phone:802-899-9991
Mailing Address - Fax:802-899-1772
Practice Address - Street 1:213E VT ROUTE 15
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:VT
Practice Address - Zip Code:05465-9639
Practice Address - Country:US
Practice Address - Phone:802-899-9991
Practice Address - Fax:802-899-1772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0000989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVN150201Medicaid
VTU64196Medicare UPIN
VTVN150201Medicaid
VT0002725Medicare PIN