Provider Demographics
NPI:1740317825
Name:MILLS, KRISTINA L (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:L
Last Name:MILLS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HAM RD
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-5202
Mailing Address - Country:US
Mailing Address - Phone:360-330-1312
Mailing Address - Fax:360-330-1320
Practice Address - Street 1:1102 KRESKY AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-3732
Practice Address - Country:US
Practice Address - Phone:360-330-1312
Practice Address - Fax:360-330-1320
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0165763OtherKRISTINA L MILLS DC L&I
WA8349722Medicaid
WA8869221OtherMMC PTAN
WA8870107OtherKRISTINA PTAN
WADB2803OtherGROUP MEDICARE RAILROAD
WA0165764OtherL&I GROUP