Provider Demographics
NPI:1902076482
Name:FLANNERY, MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:FLANNERY
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 1:1919 WILLIAMS ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2859
Mailing Address - Country:US
Mailing Address - Phone:805-991-7455
Mailing Address - Fax:805-991-7466
Practice Address - Street 1:1919 WILLIAMS ST
Practice Address - Street 2:SUITE 250
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2859
Practice Address - Country:US
Practice Address - Phone:805-991-7455
Practice Address - Fax:805-991-7466
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30513111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition