Provider Demographics
NPI:1124250832
Name:MCMILLON, JOSHUA DALE (DC)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:DALE
Last Name:MCMILLON
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 1:4717 TRIPP CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-5233
Mailing Address - Country:US
Mailing Address - Phone:503-415-1857
Mailing Address - Fax:800-319-6617
Practice Address - Street 1:6150 FALLS OF NEUSE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3528
Practice Address - Country:US
Practice Address - Phone:919-341-4691
Practice Address - Fax:800-319-6617
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3973111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
2458068Medicare PIN