MEDICARE: MCMILLAN CHIROPRACTIC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	5517	OR

General Provider Information

NPI Number	:	1285056283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCMILLAN CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	3808 N WILLIAMS AVE STE 133
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97227-1478
Country	:	US
Telephone Number	:	503-445-1188
Fax Number	:	503-445-1189

Provider Business Practice Location Address
First Line	:	3808 N WILLIAMS AVE STE 133
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97227-1478
Country	:	US
Telephone Number	:	503-445-1188
Fax Number	:	503-445-1189

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. KRISTIN LH MCMILLAN
Credential	:	DC
Telephone Number	:	503-445-1188

Provider Enumeration Date	:	01/09/2014
Last Update Date	:	12/15/2016

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