Provider Demographics
NPI:1952727372
Name:FARRELL, MINDY ANN (DC)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:ANN
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 1:2601 UNIVERSITY DR N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-1303
Mailing Address - Country:US
Mailing Address - Phone:701-364-9270
Mailing Address - Fax:701-364-9268
Practice Address - Street 1:2601 UNIVERSITY DR N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-1303
Practice Address - Country:US
Practice Address - Phone:701-364-9270
Practice Address - Fax:701-364-9268
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND965111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1464668Medicaid
ND1471124Medicaid