=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710162490
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCMILLEN CHIROPRACTIC OFFICE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2007
-----------------------------------------------------
Last Update Date | 12/07/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1155 E WATERLOO RD
-----------------------------------------------------
City | AKRON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44306-3803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-724-3519
-----------------------------------------------------
Fax | 330-785-0089
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1155 E WATERLOO RD
-----------------------------------------------------
City | AKRON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44306-3803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-724-3519
-----------------------------------------------------
Fax | 330-785-0089
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ROGER SCOTT MCMILLEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-724-2225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number | 1090
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------