Healthcare Provider Details

I. General information

NPI: 1194368068
Provider Name (Legal Business Name): STEPHEN THOMAS MILLS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15510 OLIVE BLVD STE 105
CHESTERFIELD MO
63017-0710
US

IV. Provider business mailing address

1050 W VANDAMENT AVE
YUKON OK
73099-3877
US

V. Phone/Fax

Practice location:
  • Phone: 636-346-1395
  • Fax:
Mailing address:
  • Phone: 405-354-5753
  • Fax: 405-354-5828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2019034782
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: