Provider Demographics
NPI:1114048782
Name:MILLS, FRED LEON (DC)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:LEON
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 1:331 S H ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-3403
Mailing Address - Country:US
Mailing Address - Phone:661-835-7037
Mailing Address - Fax:661-835-1702
Practice Address - Street 1:331 S H ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-3403
Practice Address - Country:US
Practice Address - Phone:661-835-7037
Practice Address - Fax:661-835-1702
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0133560Medicare ID - Type Unspecified