Provider Demographics
NPI:1629483235
Name:CONNELLY CHIROPRACTIC & MASSAGE LLC
Entity Type:Organization
Organization Name:CONNELLY CHIROPRACTIC & MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-776-5535
Mailing Address - Street 1:700 KEN PRATT BLVD
Mailing Address - Street 2:SUITE # 122
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6452
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 KEN PRATT BLVD
Practice Address - Street 2:SUITE # 122
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6452
Practice Address - Country:US
Practice Address - Phone:303-776-5535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4405111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty