Provider Demographics
NPI:1881622009
Name:FLYNN, LUCAS EDWIN (DC)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:EDWIN
Last Name:FLYNN
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 1:55 SHIAWASSEE AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3700
Mailing Address - Country:US
Mailing Address - Phone:330-836-5000
Mailing Address - Fax:330-836-5015
Practice Address - Street 1:55 SHIAWASSEE AVE STE 5
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3700
Practice Address - Country:US
Practice Address - Phone:330-836-5000
Practice Address - Fax:330-836-5015
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3513111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHFL4140492Medicare PIN
OHV00944Medicare UPIN