Provider Demographics
NPI:1003954348
Name:FAHERTY, RORY (DC)
Entity Type:Individual
Prefix:
First Name:RORY
Middle Name:
Last Name:FAHERTY
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 1:5812 LOGAN AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-2045
Mailing Address - Country:US
Mailing Address - Phone:612-922-9505
Mailing Address - Fax:
Practice Address - Street 1:24000 HIGHWAY 7 STE 215
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-2925
Practice Address - Country:US
Practice Address - Phone:952-474-2395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4910111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor