Provider Demographics
NPI:1871765800
Name:MILLARD, CHARITY ANN (DC)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:ANN
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:PO BOX 908
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-0908
Mailing Address - Country:US
Mailing Address - Phone:715-345-0655
Mailing Address - Fax:715-345-0904
Practice Address - Street 1:2610 POST RD
Practice Address - Street 2:
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467-3388
Practice Address - Country:US
Practice Address - Phone:715-345-0655
Practice Address - Fax:715-345-0904
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4368-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor