Provider Demographics
NPI:1285056283
Name:MCMILLAN CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:MCMILLAN CHIROPRACTIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:LH
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-445-1188
Mailing Address - Street 1:3808 N WILLIAMS AVE STE 133
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1478
Mailing Address - Country:US
Mailing Address - Phone:503-445-1188
Mailing Address - Fax:503-445-1189
Practice Address - Street 1:3808 N WILLIAMS AVE STE 133
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1478
Practice Address - Country:US
Practice Address - Phone:503-445-1188
Practice Address - Fax:503-445-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5517261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center