Provider Demographics
NPI:1760522254
Name:MILLS, STEPHANIE ANN (DC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:MILLS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 PEMBROKE ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NH
Mailing Address - Zip Code:03275-3246
Mailing Address - Country:US
Mailing Address - Phone:603-224-4281
Mailing Address - Fax:603-224-4281
Practice Address - Street 1:556 PEMBROKE ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NH
Practice Address - Zip Code:03275-3246
Practice Address - Country:US
Practice Address - Phone:603-224-4281
Practice Address - Fax:603-224-4281
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6171200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE6043Medicare ID - Type UnspecifiedMEDICARE ID
NHP00338986Medicare ID - Type UnspecifiedRAILROAD MEDICARE ID