Provider Demographics
NPI:1568757037
Name:MILLAN, JEFFREY S (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:MILLAN
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 1:660 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3118
Mailing Address - Country:US
Mailing Address - Phone:310-832-4476
Mailing Address - Fax:310-832-7034
Practice Address - Street 1:660 W 7TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3118
Practice Address - Country:US
Practice Address - Phone:310-832-4476
Practice Address - Fax:310-832-7034
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor