Provider Demographics
NPI:1972697860
Name:THOMAS M CONNELLY LLC
Entity Type:Organization
Organization Name:THOMAS M CONNELLY LLC
Other - Org Name:FRIENDSHIP HEIGHTS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:HAYNES
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:202-362-0900
Mailing Address - Street 1:5100 WISCONSIN AVE NW
Mailing Address - Street 2:SUITE 251
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4119
Mailing Address - Country:US
Mailing Address - Phone:202-362-0900
Mailing Address - Fax:202-362-1391
Practice Address - Street 1:5100 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 251
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4119
Practice Address - Country:US
Practice Address - Phone:202-362-0900
Practice Address - Fax:202-362-1391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC15398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG02497Medicare PIN