Healthcare Provider Details

I. General information

NPI: 1376571554
Provider Name (Legal Business Name): JOHN T FLYNN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 W DEARBORN ST
ENGLEWOOD FL
34223-3234
US

IV. Provider business mailing address

PO BOX 1534
ENGLEWOOD FL
34295-1534
US

V. Phone/Fax

Practice location:
  • Phone: 941-475-1974
  • Fax: 941-475-3657
Mailing address:
  • Phone: 941-475-1974
  • Fax: 941-475-3657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 4391
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: