=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942370556
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILLAR CHIROPRACTIC ASSOCIATES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2424 DANVILLE RD SW SUITE M
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35603-4280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-353-4500
-----------------------------------------------------
Fax | 256-301-8980
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2424 DANVILLE RD SW SUITE M
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35603-4280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-353-4500
-----------------------------------------------------
Fax | 256-301-8980
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GREGORY B. MILLAR
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 256-353-4500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 140139
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------