Provider Demographics
NPI:1063496966
Name:MILLER, DANA R (DC)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:R
Last Name:MILLER
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 1:105 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-1826
Mailing Address - Country:US
Mailing Address - Phone:208-356-6772
Mailing Address - Fax:208-356-8658
Practice Address - Street 1:105 W MAIN ST
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1826
Practice Address - Country:US
Practice Address - Phone:208-356-6772
Practice Address - Fax:208-356-8658
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCH1A39111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1671166Medicare ID - Type Unspecified