Provider Demographics
NPI:1265592844
Name:FARRELL, TIMOTHY JOSEPH (DC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOSEPH
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 1:213E VT ROUTE 15
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465-9639
Mailing Address - Country:US
Mailing Address - Phone:802-899-9991
Mailing Address - Fax:802-899-1772
Practice Address - Street 1:213E VT ROUTE 15
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:VT
Practice Address - Zip Code:05465-9639
Practice Address - Country:US
Practice Address - Phone:802-899-9991
Practice Address - Fax:802-899-1772
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0000989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN1502Medicaid
VTVN150201Medicare PIN
VTVN3202Medicare ID - Type Unspecified
VTU64196Medicare UPIN