Provider Demographics
NPI:1225107915
Name:FLYNN CHIROPRACTIC AND SPORTS REHABILITATION
Entity Type:Organization
Organization Name:FLYNN CHIROPRACTIC AND SPORTS REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-676-6556
Mailing Address - Street 1:13220 STRICKLAND RD
Mailing Address - Street 2:SUITE 184
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-5213
Mailing Address - Country:US
Mailing Address - Phone:919-676-6556
Mailing Address - Fax:919-676-9767
Practice Address - Street 1:13220 STRICKLAND RD
Practice Address - Street 2:SUITE 184
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-5213
Practice Address - Country:US
Practice Address - Phone:919-676-6556
Practice Address - Fax:919-676-9767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1425111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU05848Medicare UPIN
NC244422AMedicare ID - Type Unspecified