Provider Demographics
NPI:1780778654
Name:CONNELLY, THOMAS MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:CONNELLY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2016-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DC15398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
G025497T01Medicare PIN