Provider Demographics
NPI:1235897182
Name:FARRELLY, CONNOR ALEXANDER (DC)
Entity Type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:ALEXANDER
Last Name:FARRELLY
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 1:260 E ARMY TRAIL RD STE D
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-3005
Mailing Address - Country:US
Mailing Address - Phone:630-830-8600
Mailing Address - Fax:
Practice Address - Street 1:260 E. ARMY TRAIL ROD
Practice Address - Street 2:SUITE D
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103
Practice Address - Country:US
Practice Address - Phone:630-830-8600
Practice Address - Fax:630-830-2273
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.13788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty