Provider Demographics
NPI:1245250893
Name:FLAHERTY, JOHN MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:FLAHERTY
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 1:16 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:PAWCATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06379-1856
Mailing Address - Country:US
Mailing Address - Phone:860-599-2223
Mailing Address - Fax:888-588-1538
Practice Address - Street 1:16 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:PAWCATUCK
Practice Address - State:CT
Practice Address - Zip Code:06379-1856
Practice Address - Country:US
Practice Address - Phone:860-599-2223
Practice Address - Fax:888-588-1538
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT350001382Medicare ID - Type Unspecified