Provider Demographics
NPI:1891139218
Name:VICK, FLYNN J (DC)
Entity Type:Individual
Prefix:DR
First Name:FLYNN
Middle Name:J
Last Name:VICK
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 1:8475 N GOVERNMENT WAY
Mailing Address - Street 2:103
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8670
Mailing Address - Country:US
Mailing Address - Phone:406-581-4240
Mailing Address - Fax:
Practice Address - Street 1:8475 N GOVERNMENT WAY
Practice Address - Street 2:103
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8670
Practice Address - Country:US
Practice Address - Phone:406-581-4240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2016-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor