MEDICARE: DR. DAN A FARAH 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	2090012	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760405096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAN A FARAH DC

Provider Business Mailing Address
First Line	:	1330 VELP AVE
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54303
Country	:	US
Telephone Number	:	920-497-9499
Fax Number	:	920-497-5943

Provider Business Practice Location Address
First Line	:	1330 VELP AVE
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54303
Country	:	US
Telephone Number	:	920-497-9499
Fax Number	:	920-497-5943

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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