Healthcare Provider Details

I. General information

NPI: 1235248972
Provider Name (Legal Business Name): MILLS CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1052 MAIN STREET SUITE B
MORRO BAY CA
93442
US

IV. Provider business mailing address

1052 MAIN STREET SUITE B
MORRO BAY CA
93442
US

V. Phone/Fax

Practice location:
  • Phone: 805-772-4419
  • Fax: 805-772-2041
Mailing address:
  • Phone: 805-772-4419
  • Fax: 805-772-2041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 26103
License Number StateCA

VIII. Authorized Official

Name: DR. BENJAMIN ANDREW MILLS
Title or Position: PRESIDENT
Credential: DC
Phone: 805-772-4419