MEDICARE: MICHAEL ROY MCCONNELL D.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	0104557014	VA

General Provider Information

NPI Number	:	1700139821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ROY MCCONNELL D.C

Provider Business Mailing Address
First Line	:	951 W 21ST ST
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23517-1534
Country	:	US
Telephone Number	:	757-623-0867
Fax Number	:	757-627-2923

Provider Business Practice Location Address
First Line	:	951 W 21ST ST
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23517-1534
Country	:	US
Telephone Number	:	757-623-0867
Fax Number	:	757-627-2923

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2012
Last Update Date	:	02/14/2018

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