Provider Demographics
NPI:1023037033
Name:FLAHERTY, KIMBERLY (DC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:NAPPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:116 HAYWARD ST
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-1612
Mailing Address - Country:US
Mailing Address - Phone:781-817-5470
Mailing Address - Fax:
Practice Address - Street 1:362 BELMONT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4950
Practice Address - Country:US
Practice Address - Phone:508-584-6622
Practice Address - Fax:508-584-7744
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2576111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA470220OtherTUFTS HEALTH PLAN
MAV03740Medicare UPIN
MAY45770Medicare ID - Type Unspecified