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General NPI Number Information
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NPI Number | 1104064849
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Entity Type | Organization
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Legal Business Name | CHIROASIS A CONNOLLY CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 02/03/2009
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Last Update Date | 05/17/2010
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Provider Practice Location Address
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Address Line | 4560 ADMIRALTY WAY SUITE 252
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5423
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Country | US
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Telephone | 310-306-4828
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Fax |
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Provider Business Mailing Address
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Address Line | 4560 ADMIRALTY WAY 252
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City | MARINA DEL REY
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State | CA
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Zip | 90292
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACQUELINE CONNOLLY
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Credential | D.C.
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Telephone | 310-306-4828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State | CA
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