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General NPI Number Information
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NPI Number | 1871620773
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Entity Type | Organization
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Legal Business Name | MIRACLE MILE CHIROPRACTIC PC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 04/18/2008
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Provider Practice Location Address
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Address Line | 1102 KRESKY AVE
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City | CENTRALIA
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State | WA
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Zip | 98531-3732
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Country | US
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Telephone | 360-330-1312
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Fax | 360-330-1320
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Provider Business Mailing Address
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Address Line | 110 HAM RD
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City | CENTRALIA
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State | WA
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Zip | 98531-5202
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Country | US
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Telephone | 360-330-1312
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Fax | 360-330-1320
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Authorized Official
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Title or Position | OWNER
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Name | DR. KRISTINA L MILLS
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Credential | DC
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Telephone | 360-330-1312
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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 | CH00034048
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH00034049
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License Number State | WA
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