Provider Demographics
NPI:1710154257
Name:FLAGG, MALISSA CARNELL (DC)
Entity Type:Individual
Prefix:
First Name:MALISSA
Middle Name:CARNELL
Last Name:FLAGG
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 1:1150 US HIGHWAY 51 BYP W
Mailing Address - Street 2:SUITE A
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-1888
Mailing Address - Country:US
Mailing Address - Phone:731-286-8166
Mailing Address - Fax:731-286-1879
Practice Address - Street 1:1150 US HIGHWAY 51 BYP W
Practice Address - Street 2:SUITE A
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1888
Practice Address - Country:US
Practice Address - Phone:731-286-8166
Practice Address - Fax:731-286-1879
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000002248111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor