Provider Demographics
NPI:1154032225
Name:FLAGSHIP CHIROPRACTIC WELLNESS SC
Entity type:Organization
Organization Name:FLAGSHIP CHIROPRACTIC WELLNESS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-412-4210
Mailing Address - Street 1:106 OAK KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:VOLO
Mailing Address - State:IL
Mailing Address - Zip Code:60020-3218
Mailing Address - Country:US
Mailing Address - Phone:205-412-4210
Mailing Address - Fax:
Practice Address - Street 1:330 E MAIN ST STE 219
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3203
Practice Address - Country:US
Practice Address - Phone:205-412-4210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service