Provider Demographics
NPI:1134225659
Name:CONNELLY, PATRICK SEAN (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:SEAN
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 1:42 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06424-1059
Mailing Address - Country:US
Mailing Address - Phone:860-267-6688
Mailing Address - Fax:860-267-6614
Practice Address - Street 1:42 W HIGH ST
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:CT
Practice Address - Zip Code:06424-1059
Practice Address - Country:US
Practice Address - Phone:860-267-6688
Practice Address - Fax:860-267-6614
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT 001632111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT3943341OtherAETNA HMO
CT7197717OtherAETNA PPO
CTCT 1632OtherCONNECTICUT LICENSE
CT050001632CT01OtherBLUE CROSS BLUE SHIELD
CTCT 1632OtherCONNECTICUT LICENSE