Provider Demographics
NPI:1861558272
Name:FLYNN, JACLYN (DC)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:MCDERMOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:19 DEPOT ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01220-1856
Mailing Address - Country:US
Mailing Address - Phone:413-743-5191
Mailing Address - Fax:413-743-5192
Practice Address - Street 1:19 DEPOT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01220-1856
Practice Address - Country:US
Practice Address - Phone:413-743-5191
Practice Address - Fax:413-743-5192
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2773111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY37030OtherBCBS OF MA
MA3013231OtherCIGNA
MAAA21506OtherHPHC
MAY4573701Medicare PIN
MAY37030OtherBCBS OF MA