Healthcare Provider Details

I. General information

NPI: 1770626400
Provider Name (Legal Business Name): VICTOR K FLYNN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 BEHRMAN HWY ADVANCED MEDICAL CENTER OF GRETNA
GRETNA LA
70056
US

IV. Provider business mailing address

880 BEHRMAN HWY
GRETNA LA
70056
US

V. Phone/Fax

Practice location:
  • Phone: 504-394-0001
  • Fax: 504-394-6444
Mailing address:
  • Phone: 504-394-0001
  • Fax: 504-394-6444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1026
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: