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General NPI Number Information
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NPI Number | 1457748030
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Entity Type | Organization
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Legal Business Name | CONNOLLY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 04/21/2015
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Last Update Date | 04/21/2015
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Provider Practice Location Address
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Address Line | 2559 WASHINGTON RD SUITE 510
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City | PITTSBURGH
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State | PA
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Zip | 15241-2575
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Country | US
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Telephone | 412-913-5328
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Fax |
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Provider Business Mailing Address
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Address Line | 3260 LATONIA AVE
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City | PITTSBURGH
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State | PA
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Zip | 15216-2328
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Country | US
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Telephone | 412-913-5328
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Fax | 412-595-8111
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARMEN R CONNOLLY
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Credential | DC
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Telephone | 412-913-5328
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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 | DC010878
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License Number State | PA
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