Provider Demographics
NPI:1073521274
Name:MILLS, DOUGLAS C (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:C
Last Name:MILLS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 BALBOA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3154
Mailing Address - Country:US
Mailing Address - Phone:858-502-1250
Mailing Address - Fax:858-502-1215
Practice Address - Street 1:6565 BALBOA AVE STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3154
Practice Address - Country:US
Practice Address - Phone:858-502-1250
Practice Address - Fax:858-502-1215
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0220850OtherBLUE CROSS / SHIELD
CADC22085Medicare ID - Type Unspecified