Provider Demographics
NPI:1255497129
Name:FLYNN, KEVIN (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:FLYNN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01220-1856
Mailing Address - Country:US
Mailing Address - Phone:413-743-5191
Mailing Address - Fax:413-743-5192
Practice Address - Street 1:19 DEPOT ST
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01220-1856
Practice Address - Country:US
Practice Address - Phone:413-743-5191
Practice Address - Fax:413-743-5192
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA668804OtherHEALTH NEW ENGLAND
MA466095OtherTUFTS HEALTH PLAN
MAY37020OtherBCBS OF MA
MA668804OtherACN
MA668804OtherUNITED HEALTHCARE
MA668804OtherHEALTH NEW ENGLAND
MAY37020OtherBCBS OF MA