Provider Demographics
NPI:1720049679
Name:FLANIGAN, CHARMAGNE M (DC)
Entity Type:Individual
Prefix:
First Name:CHARMAGNE
Middle Name:M
Last Name:FLANIGAN
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 1:6005 BIG TREE ROAD
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14480-9720
Mailing Address - Country:US
Mailing Address - Phone:585-346-9150
Mailing Address - Fax:585-346-4528
Practice Address - Street 1:6005 BIG TREE ROAD
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:NY
Practice Address - Zip Code:14480-9720
Practice Address - Country:US
Practice Address - Phone:585-346-9150
Practice Address - Fax:585-346-4528
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12279AOtherMEDICARE PTAN
NY12279AOtherMEDICARE PTAN