Provider Demographics
NPI:1073672036
Name:MILLER, MARTIN W (DC)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:W
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 1:206 N GRIMMELL ROAD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:IA
Mailing Address - Zip Code:50129
Mailing Address - Country:US
Mailing Address - Phone:515-386-2515
Mailing Address - Fax:515-386-4286
Practice Address - Street 1:206 N GRIMMELL ROAD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:IA
Practice Address - Zip Code:50129
Practice Address - Country:US
Practice Address - Phone:515-386-2515
Practice Address - Fax:515-386-4286
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA57983OtherBCBS
IA1123117Medicaid
IA57983Medicare ID - Type Unspecified