MEDICARE: DR. KELLY ANNE FARRELL DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3185	OH

General Provider Information

NPI Number	:	1639128291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY ANNE FARRELL DC

Provider Business Mailing Address
First Line	:	387 EDGEBROOK RD NE
Second Line	:
City	:	BOLIVAR
State	:	OH
Zip	:	44612-8706
Country	:	US
Telephone Number	:	330-874-3545
Fax Number	:	330-874-3542

Provider Business Practice Location Address
First Line	:	387 EDGEBROOK RD NE
Second Line	:
City	:	BOLIVAR
State	:	OH
Zip	:	44612-8706
Country	:	US
Telephone Number	:	330-874-3545
Fax Number	:	330-874-3542

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	12/20/2012

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Directions to “ DR. KELLY ANNE FARRELL DC” Practice Location

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