Provider Demographics
NPI:1568575744
Name:FARRELL, DANIEL PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:PATRICK
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 1:221 W ETNA RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-5613
Mailing Address - Country:US
Mailing Address - Phone:815-431-8303
Mailing Address - Fax:815-431-8327
Practice Address - Street 1:221 W ETNA RD
Practice Address - Street 2:SUITE 6
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-5613
Practice Address - Country:US
Practice Address - Phone:815-431-8303
Practice Address - Fax:815-431-8327
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5032034OtherBC/BS PROVIDER #
IL2217577OtherFIRST HEALTH PROVIDER #
IL9395826OtherPHCS PROVIDER #
IL2217577OtherFIRST HEALTH PROVIDER #
ILU99936Medicare UPIN