Provider Demographics
NPI:1841332459
Name:FARRELL, KIMBERLY MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:MARIE
Last Name:FARRELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:MARIE
Other - Last Name:FARRELL-BARTAKIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1321 S HIGHWAY 160
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-4763
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1321 S HIGHWAY 160
Practice Address - Street 2:SUITE 7
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-4763
Practice Address - Country:US
Practice Address - Phone:775-727-6791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB661111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVVDC661Medicare ID - Type UnspecifiedCHIROPRACTIC
NVU65834Medicare UPIN