Provider Demographics
NPI:1053689018
Name:MILL POND FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MILL POND FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-219-0617
Mailing Address - Street 1:3051 KIRKLEVINGTON DR
Mailing Address - Street 2:173
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-2422
Mailing Address - Country:US
Mailing Address - Phone:925-487-0253
Mailing Address - Fax:
Practice Address - Street 1:3650 BOSTON RD
Practice Address - Street 2:SUITE E
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40514-1569
Practice Address - Country:US
Practice Address - Phone:859-219-0617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5298111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty