Provider Demographics
NPI:1447259593
Name:MCMILLAN, JAMES VINCENT (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:VINCENT
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 COFFEE RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2306
Mailing Address - Country:US
Mailing Address - Phone:209-548-9800
Mailing Address - Fax:209-548-9400
Practice Address - Street 1:2212 COFFEE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2306
Practice Address - Country:US
Practice Address - Phone:209-548-9800
Practice Address - Fax:209-548-9400
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0113400OtherPTAN