Provider Demographics
NPI:1770636169
Name:MILLS, KEITH D (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:D
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 1:2509 OCOEE ST N
Mailing Address - Street 2:SUITE D
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-5369
Mailing Address - Country:US
Mailing Address - Phone:423-478-2225
Mailing Address - Fax:423-479-7080
Practice Address - Street 1:2509 OCOEE ST N
Practice Address - Street 2:SUITE D
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-5369
Practice Address - Country:US
Practice Address - Phone:423-478-2225
Practice Address - Fax:423-479-7080
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3672754Medicaid
TN3672754Medicare ID - Type Unspecified
T74535Medicare UPIN