Provider Demographics
NPI:1508886722
Name:CONNELLY, CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:CONNELLY
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 1:2045 ROCKBRIDGE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3551
Mailing Address - Country:US
Mailing Address - Phone:770-469-7330
Mailing Address - Fax:770-469-9588
Practice Address - Street 1:2045 ROCKBRIDGE RD
Practice Address - Street 2:STE 101
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3551
Practice Address - Country:US
Practice Address - Phone:770-469-7330
Practice Address - Fax:770-469-9588
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0005997111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52663882OtherBCBS
GA350046860OtherRR MEDICARE
GAU69555Medicare UPIN
GA35ZCFDKMedicare ID - Type UnspecifiedPROVIDER ID