Provider Demographics
NPI:1063698298
Name:FLYNN, MOLLY MAE (DC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:MAE
Last Name:FLYNN
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 1:1518 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMER
Mailing Address - State:WI
Mailing Address - Zip Code:54724-1639
Mailing Address - Country:US
Mailing Address - Phone:715-568-1600
Mailing Address - Fax:715-568-1604
Practice Address - Street 1:16853 S 1ST ST
Practice Address - Street 2:
Practice Address - City:GALESVILLE
Practice Address - State:WI
Practice Address - Zip Code:54630-7191
Practice Address - Country:US
Practice Address - Phone:608-582-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4377-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38182400Medicaid
WI000770465Medicare PIN
WI000970470Medicare PIN