MEDICARE: DR. THOMAS MICHAEL CONNELLY D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	15398	DC

General Provider Information

NPI Number	:	1780778654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS MICHAEL CONNELLY D.C.

Provider Business Mailing Address
First Line	:	5100 WISCONSIN AVE NW
Second Line	:	SUITE 251
City	:	WASHINGTON
State	:	DC
Zip	:	20016-4119
Country	:	US
Telephone Number	:	202-362-0900
Fax Number	:	202-362-1391

Provider Business Practice Location Address
First Line	:	5100 WISCONSIN AVE NW
Second Line	:	SUITE 251
City	:	WASHINGTON
State	:	DC
Zip	:	20016-4119
Country	:	US
Telephone Number	:	202-362-0900
Fax Number	:	202-362-1391

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	11/14/2016

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