Provider Demographics
NPI:1124186465
Name:MILLS, BENJAMIN ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ANDREW
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 1:1052 MAIN STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442
Mailing Address - Country:US
Mailing Address - Phone:805-772-4419
Mailing Address - Fax:805-772-2041
Practice Address - Street 1:1052 MAIN STREET
Practice Address - Street 2:SUITE B
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442
Practice Address - Country:US
Practice Address - Phone:805-772-4419
Practice Address - Fax:805-772-2041
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA DC26103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14826Medicare ID - Type UnspecifiedGROUP#
CAU78807Medicare UPIN