Provider Demographics
NPI:1609024769
Name:FAHERTY, DARREN (DC)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:
Last Name:FAHERTY
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 1:5904 NE FOURTH PLAIN BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-6983
Mailing Address - Country:US
Mailing Address - Phone:360-696-8888
Mailing Address - Fax:
Practice Address - Street 1:5904 NE FOURTH PLAIN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-6983
Practice Address - Country:US
Practice Address - Phone:360-696-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60370921111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1690024769OtherANTHEM
1609024769Medicare PIN