Provider Demographics
NPI:1407232416
Name:CHARITY MILLARD DC LLC
Entity Type:Organization
Organization Name:CHARITY MILLARD DC LLC
Other - Org Name:INTEGRITY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-733-9999
Mailing Address - Street 1:1230 W COLLEGE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-5287
Mailing Address - Country:US
Mailing Address - Phone:920-733-9999
Mailing Address - Fax:920-733-9998
Practice Address - Street 1:1230 W COLLEGE AVE STE C
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-5287
Practice Address - Country:US
Practice Address - Phone:920-733-9999
Practice Address - Fax:920-733-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4368-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty