Healthcare Provider Details

I. General information

NPI: 1063698298
Provider Name (Legal Business Name): MOLLY MAE FLYNN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16853 S 1ST ST
GALESVILLE WI
54630-7191
US

IV. Provider business mailing address

1518 MAIN ST
BLOOMER WI
54724-1639
US

V. Phone/Fax

Practice location:
  • Phone: 608-582-2225
  • Fax:
Mailing address:
  • Phone: 715-568-1600
  • Fax: 715-568-1604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4377-12
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: