Provider Demographics
NPI:1598020851
Name:TERESE FARRAR CHIROPRACTIC PC
Entity Type:Organization
Organization Name:TERESE FARRAR CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-975-4057
Mailing Address - Street 1:13925 W MEEKER BLVD
Mailing Address - Street 2:#20
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4430
Mailing Address - Country:US
Mailing Address - Phone:623-975-4057
Mailing Address - Fax:623-975-4059
Practice Address - Street 1:13925 W MEEKER BLVD
Practice Address - Street 2:#20
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4430
Practice Address - Country:US
Practice Address - Phone:623-975-4057
Practice Address - Fax:623-975-4059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT76842Medicare UPIN