Provider Demographics
NPI:1811042609
Name:MILLS, GARY LYNN (DC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:LYNN
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 1:407 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-1342
Mailing Address - Country:US
Mailing Address - Phone:502-863-9987
Mailing Address - Fax:502-863-1356
Practice Address - Street 1:407 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-1342
Practice Address - Country:US
Practice Address - Phone:502-863-9987
Practice Address - Fax:502-863-1356
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3833111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000053363OtherANTHEM BC, BS
KY000000053363OtherANTHEM BC, BS