Provider Demographics
NPI:1063672756
Name:FARINELLI, EDWARD JR (DC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:FARINELLI
Suffix:JR
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 1:601 E SWALLOW RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2274
Mailing Address - Country:US
Mailing Address - Phone:970-266-1000
Mailing Address - Fax:
Practice Address - Street 1:601 E SWALLOW RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2274
Practice Address - Country:US
Practice Address - Phone:970-266-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1868111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
75-2995760OtherTID
T60541Medicare UPIN
75-2995760OtherTID