Provider Demographics
NPI:1013181429
Name:MILLSOP CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:MILLSOP CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:MILLSOP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-310-4595
Mailing Address - Street 1:3570 LEXINGTON AVE N
Mailing Address - Street 2:STE 208
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8049
Mailing Address - Country:US
Mailing Address - Phone:651-400-7026
Mailing Address - Fax:651-481-8051
Practice Address - Street 1:3570 LEXINGTON AVE N
Practice Address - Street 2:STE 208
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8049
Practice Address - Country:US
Practice Address - Phone:651-400-7026
Practice Address - Fax:651-481-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty