Healthcare Provider Details

I. General information

NPI: 1548300049
Provider Name (Legal Business Name): CROSSROADS CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 PEMBROKE ST
PEMBROKE NH
03275-3246
US

IV. Provider business mailing address

556 PEMBROKE ST
PEMBROKE NH
03275-3246
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-4281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6171200
License Number StateNH

VIII. Authorized Official

Name: STEPHANIE ANN MILLS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 603-224-4281