Provider Demographics
NPI:1245420306
Name:FARR, AZAD MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:AZAD
Middle Name:MICHAEL
Last Name:FARR
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 1:16088 BOONES FERRY RD STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4370
Mailing Address - Country:US
Mailing Address - Phone:503-496-3030
Mailing Address - Fax:503-496-5808
Practice Address - Street 1:16088 BOONES FERRY RD STE B
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4370
Practice Address - Country:US
Practice Address - Phone:503-496-3030
Practice Address - Fax:503-496-5808
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3480111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORDC02026280OtherMEDICARE