Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 38MC00618800 | NJ |
NPI | 1003996596 |
---|---|
Provider Name | Patrick David Connolly |
First Address | Asbury Park, NJ 07712 |
Second Address | Asbury Park, NJ 07712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 28/10/2019 |