Provider Demographics
NPI:1043372717
Name:FARRER, REX L (DC)
Entity type:Individual
Prefix:DR
First Name:REX
Middle Name:L
Last Name:FARRER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073
Mailing Address - Country:US
Mailing Address - Phone:207-490-2553
Mailing Address - Fax:207-490-6526
Practice Address - Street 1:1273 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073
Practice Address - Country:US
Practice Address - Phone:207-490-2553
Practice Address - Fax:207-490-6526
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME010892OtherBC
MEM20288OtherCIGNA
NH0503546Y0ME01OtherBLUE CROSS OF NEW HAMPSHIRE
ME119690000Medicaid
ME010892OtherBC
MEMM2328Medicare PIN