Healthcare Provider Details

I. General information

NPI: 1386101855
Provider Name (Legal Business Name): LEGACY INTEGRATIVE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 OHIO DR STE B
PLANO TX
75024-2262
US

IV. Provider business mailing address

8900 OHIO DR STE B
PLANO TX
75024-2262
US

V. Phone/Fax

Practice location:
  • Phone: 469-362-8701
  • Fax: 469-562-0059
Mailing address:
  • Phone: 469-362-8701
  • Fax: 469-562-0059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LOGAN J MILLS
Title or Position: OWNER
Credential: DC
Phone: 469-362-8701