Cullen Fahey

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

6403 Issued in MN

Practice address

16197 Main Ave SE
Prior Lake, MN 55372-1704

Phone

(815) 245-1018

NPI assigned

Nov 29, 2017

Last updated

Mar 16, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advantage Chiropractic and Wellness

  • Clinic/Center
  • Prior Lake, MN
  • NPI 1578077442
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1511913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584316800000",
    "number": "1457865313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 S JACKSON ST",
            "address_2": "STE 105",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802093131",
            "telephone_number": "303-474-4811",
            "fax_number": "720-750-6604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16197 MAIN AVE SE",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553721704",
            "telephone_number": "815-245-1018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAHEY",
        "first_name": "CULLEN",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-29",
        "last_updated": "2020-03-16",
        "certification_date": "2020-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CO",
            "license": "CHR.0007951",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "6403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elan Dental Arts, P.C.
• Hannah Ellenby, MSW, LICSW
• Emerald Bridge Wellness PLLC
• Enlightened Path Behavioral Health & Wellness, LLC.,
• Evergreen Real Estate Dev. Corp
• Fairview Clinics (Fairview Clinics-Prior Lake)
• Fairview Pharmacy Services LLC (Fairview Pharmacy Prior Lake)
• Neda Falak
• Freedom Transportation, LLC
• Suzannah Furber

• Chiropractor in Prior Lake, MN
• Providers in Prior Lake, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.