MEDICARE: DR. AINSLEY FLYNN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	0104-557430	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0104-557430	OTHER	VA	STATE LICENSING BOARD

General Provider Information

NPI Number	:	1376065227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AINSLEY FLYNN DC

Provider Business Mailing Address
First Line	:	400 W OLNEY RD STE E
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23507-1864
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	957 W 21ST ST STE F
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23517-1536
Country	:	US
Telephone Number	:	757-305-9996
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2017
Last Update Date	:	02/25/2019

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Directions to “ DR. AINSLEY FLYNN DC” Practice Location

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