Provider Demographics
NPI:1932110822
Name:FLACK, JULIE LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:LYNN
Last Name:FLACK
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:PO BOX 1085
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05143-1085
Mailing Address - Country:US
Mailing Address - Phone:802-875-7570
Mailing Address - Fax:802-875-7571
Practice Address - Street 1:116 MAIN ST.
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VT
Practice Address - Zip Code:05143
Practice Address - Country:US
Practice Address - Phone:802-875-7570
Practice Address - Fax:802-875-7571
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0001146111N00000X
NYX010649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor