Provider Demographics
NPI:1699879825
Name:MILLS, STEPHEN CRAIG (DC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:CRAIG
Last Name:MILLS
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 1:4501 W DEYOUNG ST
Mailing Address - Street 2:STE B-105
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-6360
Mailing Address - Country:US
Mailing Address - Phone:618-687-2396
Mailing Address - Fax:618-684-5870
Practice Address - Street 1:1010 N 14TH ST
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966
Practice Address - Country:US
Practice Address - Phone:618-687-2396
Practice Address - Fax:618-684-5870
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2020-05-13
Deactivation Date:2019-11-25
Deactivation Code:
Reactivation Date:2020-05-13
Provider Licenses
StateLicense IDTaxonomies
IL038004209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor