Basic Information
| Provider Information | |||||||||
| NPI: | 1316044068 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARR | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | RICHARD | ||||||||
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| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2725 JAMES SANDERS BLVD | ||||||||
| Address2: | STE A | ||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420018405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2705545114 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1601 HIGHWAY 121 BYP N | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420718759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702510907 | ||||||||
| FaxNumber: | 2702510908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2006 | ||||||||
| LastUpdateDate: | 03/16/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 4685 | KY | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | TB73 | 01 | KY | X PIN | OTHER | 7051 | 01 | KY | MEDICARE PTAN - PROVIDER TRANSACTION ACCESS NUMBER | OTHER | 000000216652 | 01 | KY | BCBS | OTHER |