Healthcare Provider Details

I. General information

NPI: 1881622009
Provider Name (Legal Business Name): LUCAS EDWIN FLYNN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 08/25/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SHIAWASSEE AVE STE 5
FAIRLAWN OH
44333-3700
US

IV. Provider business mailing address

55 SHIAWASSEE AVE STE 5
FAIRLAWN OH
44333-3700
US

V. Phone/Fax

Practice location:
  • Phone: 330-836-5000
  • Fax: 330-836-5015
Mailing address:
  • Phone: 330-836-5000
  • Fax: 330-836-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3513
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: