MEDICARE: MILLS RIVER FAMILY CHIROPRACTIC, PA

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	111NN0400X	Neurology Chiropractor	NC2118	NC
2	111N00000X	Chiropractor	NC2083	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0862E	OTHER	NC	NC STATE HEALTH PLAN
3	0862E	OTHER	NC	BC OF NC

General Provider Information

NPI Number	:	1457393753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLS RIVER FAMILY CHIROPRACTIC, PA

Provider Business Mailing Address
First Line	:	4170 HAYWOOD RD
Second Line	:
City	:	MILLS RIVER
State	:	NC
Zip	:	28759-9740
Country	:	US
Telephone Number	:	828-891-8868
Fax Number	:	828-891-8897

Provider Business Practice Location Address
First Line	:	4170 HAYWOOD RD # D
Second Line	:
City	:	MILLS RIVER
State	:	NC
Zip	:	28759-9740
Country	:	US
Telephone Number	:	828-891-8868
Fax Number	:	828-891-8897

Authorized Official
Title or Position	:	DOCTOR CO OWNER OF PRACTICE
Name	:	DR. LAURA L GROSS
Credential	:	DC
Telephone Number	:	828-891-8868

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	05/14/2021

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Directions to “MILLS RIVER FAMILY CHIROPRACTIC, PA ” Practice Location

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