Provider Demographics
NPI:1740229947
Name:FARRELL, MICHAEL J (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
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 1:31 N LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-3115
Mailing Address - Country:US
Mailing Address - Phone:215-572-1580
Mailing Address - Fax:215-754-4917
Practice Address - Street 1:270 N KESWICK AVE
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-4826
Practice Address - Country:US
Practice Address - Phone:215-572-1580
Practice Address - Fax:215-754-4917
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006126L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0867776000OtherBLUE CROSS/BLUS SHIELD
PA835919Medicare ID - Type Unspecified