Healthcare Provider Details

I. General information

NPI: 1457393753
Provider Name (Legal Business Name): MILLS RIVER FAMILY CHIROPRACTIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4170 HAYWOOD RD # D
MILLS RIVER NC
28759-9740
US

IV. Provider business mailing address

4170 HAYWOOD RD
MILLS RIVER NC
28759-9740
US

V. Phone/Fax

Practice location:
  • Phone: 828-891-8868
  • Fax: 828-891-8897
Mailing address:
  • Phone: 828-891-8868
  • Fax: 828-891-8897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberNC2083
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberNC2118
License Number StateNC

VIII. Authorized Official

Name: DR. LAURA L GROSS
Title or Position: DOCTOR CO OWNER OF PRACTICE
Credential: DC
Phone: 828-891-8868