Provider Demographics
NPI:1821293861
Name:MILLARD CHIROPRACTIC PC
Entity Type:Organization
Organization Name:MILLARD CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-465-2020
Mailing Address - Street 1:1206 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:IA
Mailing Address - Zip Code:50220-1632
Mailing Address - Country:US
Mailing Address - Phone:515-465-2020
Mailing Address - Fax:515-465-3388
Practice Address - Street 1:1206 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:IA
Practice Address - Zip Code:50220-1632
Practice Address - Country:US
Practice Address - Phone:515-465-2020
Practice Address - Fax:515-465-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0206748Medicaid
IA16846OtherBCBS
IA623000OtherUHC
IA0206748Medicaid