Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 1868 | CO |
NPI | 1063672756 |
---|---|
Provider Name | Edward Farinelli JR. |
First Address | Fort Collins, CO 80525-2274 |
Second Address | Fort Collins, CO 80525-2274 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2008 |
Last Update Date | 16/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
75-2995760 | TID (01) | |
T60541 | (02) |