Provider Demographics
NPI:1114031390
Name:FLYNN, JAQUELINE (DC)
Entity Type:Individual
Prefix:DR
First Name:JAQUELINE
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 MEADOW STREET SUITE 3
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4180
Mailing Address - Country:US
Mailing Address - Phone:203-723-5715
Mailing Address - Fax:203-725-0540
Practice Address - Street 1:223 MEADOW STREET SUITE 3
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4180
Practice Address - Country:US
Practice Address - Phone:203-723-5715
Practice Address - Fax:203-725-0540
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001569111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor