Provider Demographics
NPI:1366477341
Name:FLYNN, PATRICK MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:MICHAEL
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 1:2525 W MASON ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-4838
Mailing Address - Country:US
Mailing Address - Phone:920-429-2844
Mailing Address - Fax:920-429-2845
Practice Address - Street 1:2525 W MASON ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-4838
Practice Address - Country:US
Practice Address - Phone:920-429-2844
Practice Address - Fax:920-429-2845
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007993111N00000X
WI3623-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38940200Medicaid
WI392039747012OtherBLUE CROSS BLUE SHIELD #
WI38940200Medicaid