Provider Demographics
NPI:1982759627
Name:GARY L. MILLS D.C.P.S.C.
Entity Type:Organization
Organization Name:GARY L. MILLS D.C.P.S.C.
Other - Org Name:MILLS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES. & CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-863-9987
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3833261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000053363OtherANTHEM BC, BS
KY000000053363OtherANTHEM BC, BS