Healthcare Provider Details

I. General information

NPI: 1780805572
Provider Name (Legal Business Name): AUSTIN D. MCMILLIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1922 64TH AVE W
TACOMA WA
98466-6203
US

IV. Provider business mailing address

1922 64TH AVE W
TACOMA WA
98466-6203
US

V. Phone/Fax

Practice location:
  • Phone: 253-564-1288
  • Fax:
Mailing address:
  • Phone: 253-564-1288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH00002338
License Number StateWA

VIII. Authorized Official

Name: DR. AUSTIN DAVID MCMILLIN
Title or Position: PRESIDENT
Credential: DC
Phone: 253-564-1288