Provider Demographics
NPI:1336394774
Name:MILLS CHIROPRACTIC CENTER CHARTERED
Entity type:Organization
Organization Name:MILLS CHIROPRACTIC CENTER CHARTERED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-646-8700
Mailing Address - Street 1:6837 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1635
Mailing Address - Country:US
Mailing Address - Phone:702-646-8700
Mailing Address - Fax:702-240-2072
Practice Address - Street 1:6837 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1635
Practice Address - Country:US
Practice Address - Phone:702-646-8700
Practice Address - Fax:702-240-2072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV37230Medicare PIN
NVT67302Medicare UPIN