Provider Demographics
NPI:1790020030
Name:FARRELL, ROBERT JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:FARRELL
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 1:15817 BERNARDO CENTER DR STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-2322
Mailing Address - Country:US
Mailing Address - Phone:858-674-7200
Mailing Address - Fax:858-674-7277
Practice Address - Street 1:15817 BERNARDO CENTER DR
Practice Address - Street 2:105
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-2353
Practice Address - Country:US
Practice Address - Phone:858-674-7200
Practice Address - Fax:858-674-7277
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor