Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | IL |
NPI | 1588772149 |
---|---|
Provider Name | Dr. Terrance Martin Flanagan |
First Address | Oak Lawn, IL 60453-2074 |
Second Address | Oak Lawn, IL 60453-2074 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 05/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1682556 | BCBS (01) | IL |
T38020 | (02) | IL |