Provider Demographics
NPI:1962953026
Name:FAHRENDORF, ERIC MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MICHAEL
Last Name:FAHRENDORF
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 1:3909 S SOUTHEASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-7186
Mailing Address - Country:US
Mailing Address - Phone:605-334-8000
Mailing Address - Fax:605-330-0889
Practice Address - Street 1:3909 S SOUTHEASTERN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-7186
Practice Address - Country:US
Practice Address - Phone:605-334-8000
Practice Address - Fax:605-330-0889
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1298111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor