Provider Demographics
NPI:1467458430
Name:MILLS, JON L (DC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:L
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 1:4601 COLLEYVILLE BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-3975
Mailing Address - Country:US
Mailing Address - Phone:817-581-0123
Mailing Address - Fax:817-581-0124
Practice Address - Street 1:4601 COLLEYVILLE BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-3975
Practice Address - Country:US
Practice Address - Phone:817-581-0123
Practice Address - Fax:817-581-2211
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2011-08-04
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
TX7316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605728Medicare UPIN