Provider Demographics
NPI:1962524660
Name:FARRELL, ANGELICA (DC)
Entity type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:
Last Name:FARRELL
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 1:443 ROHNERT PARK EXPY W
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-7907
Mailing Address - Country:US
Mailing Address - Phone:707-206-9717
Mailing Address - Fax:707-206-9509
Practice Address - Street 1:443 ROHNERT PARK EXPY W
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-7907
Practice Address - Country:US
Practice Address - Phone:707-206-9717
Practice Address - Fax:707-206-9509
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27429111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor