Provider Demographics
NPI:1447223755
Name:MILLARD, DEBRA S (DC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:S
Last Name:MILLARD
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 1:1206 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:IA
Mailing Address - Zip Code:50220
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
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA16846OtherBCBS
IA0206748Medicaid
IA0206748Medicaid