Provider Demographics
NPI:1790857266
Name:MCMILLAN, CHRISTOPHER (LAC, MSOM, ND)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:LAC, MSOM, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 739
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-0156
Mailing Address - Country:US
Mailing Address - Phone:360-589-2706
Mailing Address - Fax:360-533-4279
Practice Address - Street 1:313 S I ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6615
Practice Address - Country:US
Practice Address - Phone:360-589-2706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002542171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4458MCOtherREGENCE BLUESHIELD NUMBER
WA6744MCOtherREGENCE BLUESHIELD NUMBER