Provider Demographics
NPI:1235422148
Name:FARRAR, KEVIN WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:WAYNE
Last Name:FARRAR
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 1:4152 W SPRING CREEK PKWY
Mailing Address - Street 2:SUITE 116
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5314
Mailing Address - Country:US
Mailing Address - Phone:972-964-7000
Mailing Address - Fax:972-964-7005
Practice Address - Street 1:4152 W SPRING CREEK PKWY
Practice Address - Street 2:SUITE 116
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-5314
Practice Address - Country:US
Practice Address - Phone:972-964-7000
Practice Address - Fax:972-964-7005
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11751111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor