Healthcare Provider Details

I. General information

NPI: 1093248007
Provider Name (Legal Business Name): EMILY LOUISE FLYNN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9138 BONITA BEACH RD SE
BONITA SPRINGS FL
34135-4291
US

IV. Provider business mailing address

9138 BONITA BEACH RD SE
BONITA SPRINGS FL
34135-4291
US

V. Phone/Fax

Practice location:
  • Phone: 239-908-9762
  • Fax:
Mailing address:
  • Phone: 239-908-9762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH12155
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: