Provider Demographics
NPI:1710162490
Name:MCMILLEN CHIROPRACTIC OFFICE, INC
Entity Type:Organization
Organization Name:MCMILLEN CHIROPRACTIC OFFICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MCMILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-724-2225
Mailing Address - Street 1:1155 E WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-3803
Mailing Address - Country:US
Mailing Address - Phone:330-724-3519
Mailing Address - Fax:330-785-0089
Practice Address - Street 1:1155 E WATERLOO RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-3803
Practice Address - Country:US
Practice Address - Phone:330-724-3519
Practice Address - Fax:330-785-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1090111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9287321Medicare PIN
OHT80744Medicare UPIN