Healthcare Provider Details

I. General information

NPI: 1265443543
Provider Name (Legal Business Name): TIMOTHY R MILLS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8244 S LEWIS AVE
TULSA OK
74137-1267
US

IV. Provider business mailing address

8244 S LEWIS AVE
TULSA OK
74137-1267
US

V. Phone/Fax

Practice location:
  • Phone: 918-298-4500
  • Fax: 918-298-4500
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2663
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number304
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: