Healthcare Provider Details

I. General information

NPI: 1679940712
Provider Name (Legal Business Name): FLYNN BROWN CHIROPRACTIC, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 78TH ST STE 100
VICTORIA MN
55386-9723
US

IV. Provider business mailing address

1405 78TH ST STE 100
VICTORIA MN
55386-9723
US

V. Phone/Fax

Practice location:
  • Phone: 952-443-3710
  • Fax: 952-443-3761
Mailing address:
  • Phone: 952-443-3710
  • Fax: 952-443-3761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number5451
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5437
License Number StateMN

VIII. Authorized Official

Name: ERIN FLYNN-BROWN
Title or Position: CO-OWNER
Credential: DC
Phone: 651-600-2540