Provider Demographics
NPI:1003237009
Name:FARRELL, MALORIE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:MALORIE
Middle Name:ANN
Last Name:FARRELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MALORIE
Other - Middle Name:ANN
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 362
Mailing Address - Street 2:
Mailing Address - City:WADDINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:13694-0362
Mailing Address - Country:US
Mailing Address - Phone:315-388-3119
Mailing Address - Fax:315-293-2051
Practice Address - Street 1:7 MAIN ST
Practice Address - Street 2:
Practice Address - City:WADDINGTON
Practice Address - State:NY
Practice Address - Zip Code:13694
Practice Address - Country:US
Practice Address - Phone:315-388-3119
Practice Address - Fax:315-293-2051
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor