Healthcare Provider Details

I. General information

NPI: 1952478372
Provider Name (Legal Business Name): LYMAN CONNOLLY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 03/21/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5873 EL CAJON BLVD
SAN DIEGO CA
92115-3741
US

IV. Provider business mailing address

5873 EL CAJON BLVD
SAN DIEGO CA
92115-3741
US

V. Phone/Fax

Practice location:
  • Phone: 619-286-5352
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC13989
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number00
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDIPLOMATE
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE152026
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number9855511-4810
License Number StateUT
# 6
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberDC13989
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: