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General NPI Number Information
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NPI Number | 1134411689
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Entity Type | Organization
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Legal Business Name | PROACTIVE HEALTH CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 05/03/2011
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 6150 FALLS OF NEUSE RD
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City | RALEIGH
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State | NC
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Zip | 27609-3528
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Country | US
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Telephone | 919-341-4691
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Fax |
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Provider Business Mailing Address
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Address Line | 4717 TRIPP CT
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City | RALEIGH
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State | NC
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Zip | 27616-5233
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Country | US
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Telephone | 503-415-1857
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSHUA D MCMILLON
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Credential | D.C.
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Telephone | 503-415-1857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3973
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License Number State | NC
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