Provider Demographics
NPI:1477790970
Name:CONNELLY, DEBORAH MICHELE (DC)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:MICHELE
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ISAAC ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-4107
Mailing Address - Country:US
Mailing Address - Phone:203-838-3439
Mailing Address - Fax:203-838-8585
Practice Address - Street 1:16 ISAAC ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-4107
Practice Address - Country:US
Practice Address - Phone:203-838-3439
Practice Address - Fax:203-838-8585
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001298111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU96560Medicare UPIN