Healthcare Provider Details

I. General information

NPI: 1821229204
Provider Name (Legal Business Name): GREGORY DARR FLYNN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 08/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 COLUMBIA AVE E
BATTLE CREEK MI
49014-5412
US

IV. Provider business mailing address

501 COLUMBIA AVE E
BATTLE CREEK MI
49014-5412
US

V. Phone/Fax

Practice location:
  • Phone: 269-962-2836
  • Fax: 269-788-9312
Mailing address:
  • Phone: 269-962-2836
  • Fax: 269-788-9312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC3296
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: