Individual provider Active NPI

Che C Connelly, DC

  • Chiropractor
  • Longmont, CO
National Provider Identifier
1942340732
Registry record updated Feb 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4405 Issued in CO
Practice address
700 Ken Pratt Blvd
#122
Longmont, CO 80501-6452
Phone
(303) 776-5535
Fax
(303) 776-3244
NPI assigned
Feb 8, 2007
Last updated
Feb 17, 2017By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 17, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4405 CO Primary

Addresses

Primary practice location

700 Ken Pratt Blvd
#122
Longmont, CO 80501-6452

Mailing address

700 Ken Pratt Blvd
#122
Longmont, CO 80501-6452
Phone (303) 776-5535

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081209000809 CO Practitioner - Chiropractic 3971664988 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 1995
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

700 Ken Pratt Blvd
Suite 122
Longmont, CO 80501-3606
Phone (303) 776-5535

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4405COMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Connelly Chiropractic & Massage LLC Chiropractor CurrentSince May 16, 2014 Accepting new patients
Connelly Chiropractic, P.C. Chiropractor Past Accepting new patients

Locations

700 Ken Pratt Blvd
Ste 122
Longmont, CO 80501
Phone (303) 776-5535

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487289600000",
    "number": "1942340732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 KEN PRATT BLVD",
            "address_2": "#122",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805016452",
            "telephone_number": "303-776-5535",
            "fax_number": "303-776-3244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 KEN PRATT BLVD",
            "address_2": "#122",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805016452",
            "telephone_number": "303-776-5535",
            "fax_number": "303-776-3244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNELLY",
        "first_name": "CHE",
        "middle_name": "C",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-08",
        "last_updated": "2017-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CO",
            "license": "4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longmont, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.