Provider Demographics
NPI:1073579579
Name:MILLER, MARK DARRYL (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DARRYL
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 1:1200 BYPASS RD
Mailing Address - Street 2:STE B
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-2724
Mailing Address - Country:US
Mailing Address - Phone:859-744-3700
Mailing Address - Fax:859-744-3262
Practice Address - Street 1:1200 BYPASS RD
Practice Address - Street 2:STE B
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-2724
Practice Address - Country:US
Practice Address - Phone:859-744-3700
Practice Address - Fax:859-744-3262
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY607451OtherACN
KY4596OtherCHA
KY44-00065OtherUNITED HEALTH CARE
KY607451OtherAETNA
KY000000062838OtherBLUE CROSS BLUE SHIELD
KY607451OtherAETNA
KYT78570Medicare UPIN