1740317825 NPI number — DR. KRISTINA L MILLS DC

Table of content: DR. KRISTINA L MILLS DC (NPI 1740317825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740317825 NPI number — DR. KRISTINA L MILLS DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLS
Provider First Name:
KRISTINA
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740317825
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 HAM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTRALIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98531-5202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-330-1312
Provider Business Mailing Address Fax Number:
360-330-1320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1102 KRESKY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTRALIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98531-3732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-330-1312
Provider Business Practice Location Address Fax Number:
360-330-1320
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH00034048 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0165763 . This is a "KRISTINA L MILLS DC L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8349722 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8869221 . This is a "MMC PTAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8870107 . This is a "KRISTINA PTAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: DB2803 . This is a "GROUP MEDICARE RAILROAD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0165764 . This is a "L&I GROUP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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