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General NPI Number Information
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NPI Number | 1790978948
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Entity Type | Organization
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Legal Business Name | M&M ENTERPRISES
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 08/21/2007
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Provider Practice Location Address
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Address Line | 300 W CARL ALBERT PKWY
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City | MCALESTER
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State | OK
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Zip | 74501-4419
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Country | US
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Telephone | 918-423-1879
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Fax | 918-423-2946
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Provider Business Mailing Address
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Address Line | 300 W CARL ALBERT PKWY
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City | MCALESTER
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State | OK
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Zip | 74501-4419
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Country | US
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Telephone | 918-423-1879
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Fax | 918-423-2946
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | DR. SHANE M MILLS
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Credential | D.C.
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Telephone | 918-423-1879
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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 | 3189
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License Number State | OK
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