Provider Demographics
NPI:1467445247
Name:FARRELL, R. PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:R. PATRICK
Middle Name:
Last Name:FARRELL
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 1:2724 SE GAY ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-5911
Mailing Address - Country:US
Mailing Address - Phone:772-286-1720
Mailing Address - Fax:772-286-7141
Practice Address - Street 1:2724 SE GAY ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-5911
Practice Address - Country:US
Practice Address - Phone:772-286-1720
Practice Address - Fax:772-286-7141
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2010-07-30
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
FLCH0002805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88220Medicare ID - Type Unspecified