Provider Demographics
NPI:1356528780
Name:CONNELL, DAVID BRADFORD (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRADFORD
Last Name:CONNELL
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 1:516 HAIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2476
Mailing Address - Country:US
Mailing Address - Phone:845-485-8582
Mailing Address - Fax:845-485-1866
Practice Address - Street 1:516 HAIGHT AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2476
Practice Address - Country:US
Practice Address - Phone:845-485-8582
Practice Address - Fax:845-485-1866
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005046-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX28441Medicare UPIN