Provider Demographics
NPI:1972557478
Name:CONNELL, DUANE H (DC)
Entity type:Individual
Prefix:DR
First Name:DUANE
Middle Name:H
Last Name:CONNELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 GRAFTON STATION LN
Mailing Address - Street 2:SUITE G
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692-4776
Mailing Address - Country:US
Mailing Address - Phone:757-989-5393
Mailing Address - Fax:757-989-0551
Practice Address - Street 1:121 GRAFTON STATION LN
Practice Address - Street 2:SUITEG
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-4776
Practice Address - Country:US
Practice Address - Phone:757-989-5393
Practice Address - Fax:757-989-0551
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA331889OtherBCBS GROUP NUMBER
VA331890OtherBCBS PIN