Healthcare Provider Details

I. General information

NPI: 1235397886
Provider Name (Legal Business Name): TIMOTHY FLYNN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N MAIN ST
CRESTVIEW FL
32536-3546
US

IV. Provider business mailing address

102 N MAIN ST
CRESTVIEW FL
32536-3546
US

V. Phone/Fax

Practice location:
  • Phone: 850-682-9697
  • Fax: 850-683-9670
Mailing address:
  • Phone: 850-682-9697
  • Fax: 850-683-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH7375
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: