Provider Demographics
NPI:1053307439
Name:MILLER, DUANE DALE (DC)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:DALE
Last Name:MILLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:DUANE
Other - Middle Name:DALE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:710 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-1838
Mailing Address - Country:US
Mailing Address - Phone:304-845-2534
Mailing Address - Fax:304-843-1197
Practice Address - Street 1:144 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041-1029
Practice Address - Country:US
Practice Address - Phone:304-843-1192
Practice Address - Fax:304-843-1197
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV628111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001710780OtherMOUNTAIN STATE BCBS
WV5472552OtherAETNA
WV3797826-001OtherCIGNA
WV628OtherHEALTH PLAN
WV0775005000OtherWV MEDICAID
WV550760012-00OtherWV WORKERS COMPENSATION
WV3797826-001OtherCIGNA