Provider Demographics
NPI:1053902106
Name:FARLEY, JEDIDIAH RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:JEDIDIAH
Middle Name:RICHARD
Last Name:FARLEY
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 1:4225 S. 2700 E
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84124
Mailing Address - Country:US
Mailing Address - Phone:801-960-5005
Mailing Address - Fax:385-695-5984
Practice Address - Street 1:2040 E MURRAY HOLLADAY RD
Practice Address - Street 2:SUITE 102 A
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117
Practice Address - Country:US
Practice Address - Phone:801-372-5864
Practice Address - Fax:385-695-5984
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10943391-1202111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician