Healthcare Provider Details

I. General information

NPI: 1972557478
Provider Name (Legal Business Name): DUANE H CONNELL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 GRAFTON STATION LN SUITEG
YORKTOWN VA
23692-4776
US

IV. Provider business mailing address

121 GRAFTON STATION LN SUITE G
YORKTOWN VA
23692-4776
US

V. Phone/Fax

Practice location:
  • Phone: 757-989-5393
  • Fax: 757-989-0551
Mailing address:
  • Phone: 757-989-5393
  • Fax: 757-989-0551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104001296
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: