Provider Demographics
NPI:1457393753
Name:MILLS RIVER FAMILY CHIROPRACTIC, PA
Entity type:Organization
Organization Name:MILLS RIVER FAMILY CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR CO OWNER OF PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:828-891-8868
Mailing Address - Street 1:4170 HAYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MILLS RIVER
Mailing Address - State:NC
Mailing Address - Zip Code:28759-9740
Mailing Address - Country:US
Mailing Address - Phone:828-891-8868
Mailing Address - Fax:828-891-8897
Practice Address - Street 1:4170 HAYWOOD RD # D
Practice Address - Street 2:
Practice Address - City:MILLS RIVER
Practice Address - State:NC
Practice Address - Zip Code:28759-9740
Practice Address - Country:US
Practice Address - Phone:828-891-8868
Practice Address - Fax:828-891-8897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC2118111NN0400X
NCNC2083111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890862EMedicaid
NC0862EOtherNC STATE HEALTH PLAN
NC0862EOtherBC OF NC
NC0862EOtherNC STATE HEALTH PLAN
NC890862EMedicaid