Active NPI
Mason Connolly, D.C.
- Chiropractor
- O'Fallon, IL
National Provider Identifier
1336154210
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 038-009170
- Practice address
- 138C Eagle Dr
O Fallon, IL 62269-1882 - Phone
- (618) 622-1793
- Fax
- (618) 622-1795
- NPI assigned
- Jul 29, 2006
- Last updated
- Oct 4, 2016
- 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 | 038-009170 | IL | Primary |
Addresses
Primary practice location
138C Eagle Dr
O Fallon, IL 62269-1882
Mailing address
138C Eagle Dr
O Fallon, IL 62269-1882
Phone (618) 622-1793
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08227539 | Other | IL | BLUECROSS/ BLUE SHIELD |
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 |
|---|---|---|---|
| 038-009170 | IL | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154131200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475539200000",
"number": "1336154210",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "138C EAGLE DR",
"city": "O FALLON",
"state": "IL",
"postal_code": "622691882",
"telephone_number": "618-622-1793",
"fax_number": "618-622-1795"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "138C EAGLE DR",
"city": "O FALLON",
"state": "IL",
"postal_code": "622691882",
"telephone_number": "618-622-1793",
"fax_number": "618-622-1795"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNOLLY",
"first_name": "MASON",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-29",
"last_updated": "2016-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "IL",
"license": "038-009170",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS/ BLUE SHIELD",
"identifier": "08227539",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in O'Fallon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.