Provider Demographics
NPI:1396016085
Name:MILLPOND FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:MILLPOND FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:925-487-0253
Mailing Address - Street 1:3650 BOSTON RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1569
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:925-487-0253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty