Provider Demographics
NPI:1376571554
Name:FLYNN, JOHN T (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
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:PO BOX 1534
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34295-1534
Mailing Address - Country:US
Mailing Address - Phone:941-475-1974
Mailing Address - Fax:941-475-3657
Practice Address - Street 1:77 W DEARBORN ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-3234
Practice Address - Country:US
Practice Address - Phone:941-475-1974
Practice Address - Fax:941-475-3657
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 4391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU02602Medicare UPIN