Healthcare Provider Details

I. General information

NPI: 1578798492
Provider Name (Legal Business Name): CARLEY FARDELL D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 06/24/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 RIVER ST
ELK RAPIDS MI
49629-9614
US

IV. Provider business mailing address

309 FAIRBANKS ST
ELK RAPIDS MI
49629-9751
US

V. Phone/Fax

Practice location:
  • Phone: 231-260-9080
  • Fax: 717-313-4388
Mailing address:
  • Phone: 231-260-9080
  • Fax: 717-313-4388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301010662
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: