Provider Demographics
NPI:1821229204
Name:FLYNN, GREGORY DARR
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:DARR
Last Name:FLYNN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 COLUMBIA AVE E
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-5412
Mailing Address - Country:US
Mailing Address - Phone:269-962-2836
Mailing Address - Fax:269-788-9312
Practice Address - Street 1:501 COLUMBIA AVE E
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-5412
Practice Address - Country:US
Practice Address - Phone:269-962-2836
Practice Address - Fax:269-788-9312
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3296171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist