Provider Demographics
NPI:1578798492
Name:FARDELL, CARLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:CARLEY
Middle Name:
Last Name:FARDELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 FAIRBANKS ST
Mailing Address - Street 2:
Mailing Address - City:ELK RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49629-9751
Mailing Address - Country:US
Mailing Address - Phone:231-260-9080
Mailing Address - Fax:717-313-4388
Practice Address - Street 1:146 RIVER ST
Practice Address - Street 2:
Practice Address - City:ELK RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49629-9614
Practice Address - Country:US
Practice Address - Phone:231-260-9080
Practice Address - Fax:717-313-4388
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor