Provider Demographics
NPI:1700139821
Name:MCCONNELL, MICHAEL ROY (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROY
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-1534
Mailing Address - Country:US
Mailing Address - Phone:757-623-0867
Mailing Address - Fax:757-627-2923
Practice Address - Street 1:951 W 21ST ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1534
Practice Address - Country:US
Practice Address - Phone:757-623-0867
Practice Address - Fax:757-627-2923
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557014111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor