MEDICARE: DR. DUANE H CONNELL DC

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	0104001296	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	331889	OTHER	VA	BCBS GROUP NUMBER
2	331890	OTHER	VA	BCBS PIN

General Provider Information

NPI Number	:	1972557478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUANE H CONNELL DC

Provider Business Mailing Address
First Line	:	121 GRAFTON STATION LN
Second Line	:	SUITE G
City	:	YORKTOWN
State	:	VA
Zip	:	23692-4776
Country	:	US
Telephone Number	:	757-989-5393
Fax Number	:	757-989-0551

Provider Business Practice Location Address
First Line	:	121 GRAFTON STATION LN
Second Line	:	SUITEG
City	:	YORKTOWN
State	:	VA
Zip	:	23692-4776
Country	:	US
Telephone Number	:	757-989-5393
Fax Number	:	757-989-0551

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/09/2007

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Directions to “ DR. DUANE H CONNELL DC” Practice Location

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