MEDICARE: YVONNE CONNOLLY 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	DC003733L	PA

General Provider Information

NPI Number	:	1841698560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVONNE CONNOLLY D.C.

Provider Business Mailing Address
First Line	:	58 OAKTREE DR
Second Line	:
City	:	LEVITTOWN
State	:	PA
Zip	:	19055-1526
Country	:	US
Telephone Number	:	215-932-0830
Fax Number	:

Provider Business Practice Location Address
First Line	:	2437 ARAMINGO AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-3707
Country	:	US
Telephone Number	:	267-519-8788
Fax Number	:

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

Provider Enumeration Date	:	12/11/2014
Last Update Date	:	12/11/2014

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