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General NPI Number Information
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NPI Number | 1811392525
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Entity Type | Organization
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Legal Business Name | CONNOLLY FAMILY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 10/24/2014
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Last Update Date | 12/22/2014
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Provider Practice Location Address
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Address Line | 545 E MARKET ST
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City | LEESBURG
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State | VA
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Zip | 20176-4172
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Country | US
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Telephone | 443-255-4283
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Fax |
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Provider Business Mailing Address
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Address Line | 545 E MARKET ST
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City | LEESBURG
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State | VA
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Zip | 20176-4172
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Country | US
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Telephone | 443-255-4283
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KELAN OLIVER CONNOLLY
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Credential | D.C.
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Telephone | 443-255-4283
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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 | 0104557104
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License Number State | VA
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