MEDICARE: CONNELLY CHIROPRACTIC, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1306097779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNELLY CHIROPRACTIC, P.C.

Provider Business Mailing Address
First Line	:	1325 DRY CREEK DR
Second Line	:	204
City	:	LONGMONT
State	:	CO
Zip	:	80503-7731
Country	:	US
Telephone Number	:	303-776-5535
Fax Number	:	303-776-3244

Provider Business Practice Location Address
First Line	:	1325 DRY CREEK DR
Second Line	:	204
City	:	LONGMONT
State	:	CO
Zip	:	80503-7731
Country	:	US
Telephone Number	:	303-776-5535
Fax Number	:	303-776-3244

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHE CHRISTOPHER CONNELLY
Credential	:	D.C.
Telephone Number	:	303-776-5535

Provider Enumeration Date	:	10/03/2008
Last Update Date	:	10/03/2008

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