Healthcare Provider Details

I. General information

NPI: 1255667309
Provider Name (Legal Business Name): MARCIA DIANNE CONNELLY L.A.C. DTCM, DIPL.OM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 SEA RIDGE RD
APTOS CA
95003-4364
US

IV. Provider business mailing address

PO BOX 689
FREEDOM CA
95019-0689
US

V. Phone/Fax

Practice location:
  • Phone: 831-818-7051
  • Fax:
Mailing address:
  • Phone: 831-818-7051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number13176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: