Individual
MASON CONNOLLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
138C EAGLE DR, O FALLON, IL 62269-1882
(618) 622-1793
(618) 622-1795
Mailing address
138C EAGLE DR, O FALLON, IL 62269-1882
(618) 622-1793
(618) 622-1795
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038-009170
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08227539
BLUECROSS/ BLUE SHIELD
IL
Enumeration date
07/29/2006
Last updated
10/04/2016
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