Active NPI
Charles John Connolly Jr., DC
- Chiropractor
- Dix Hills, NY
National Provider Identifier
1174779391
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- X005460-1
- Practice address
- 15 Millet St
Dix Hills, NY 11746 - Phone
- (631) 667-7600
- Fax
- (631) 667-7600
- NPI assigned
- Aug 8, 2008
- Last updated
- Aug 8, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | X005460-1 | NY | Primary |
Addresses
Primary practice location
15 Millet St
Dix Hills, NY 11746
Mailing address
15 Millet St
Dix Hills, NY 11746
Phone (631) 667-7600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| X005460-1 | NY | MD | Chiropractor |
| 005460 | NY | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218153600000",
"number": "1174779391",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 MILLET ST",
"city": "DIX HILLS",
"state": "NY",
"postal_code": "11746",
"telephone_number": "631-667-7600",
"fax_number": "631-667-7600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 MILLET ST",
"city": "DIX HILLS",
"state": "NY",
"postal_code": "11746",
"telephone_number": "631-667-7600",
"fax_number": "631-667-7600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNOLLY",
"first_name": "CHARLES",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-08-08",
"last_updated": "2008-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "NY",
"license": "X005460-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dix Hills, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.