Provider Demographics
NPI:1073676086
Name:MILLER, SHERWIN SR (DC)
Entity Type:Individual
Prefix:
First Name:SHERWIN
Middle Name:
Last Name:MILLER
Suffix:SR
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 1:500B MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-1321
Mailing Address - Country:US
Mailing Address - Phone:304-872-2736
Mailing Address - Fax:304-872-2736
Practice Address - Street 1:500B MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1321
Practice Address - Country:US
Practice Address - Phone:304-872-2736
Practice Address - Fax:304-872-2736
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV694111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7600021000Medicaid
WVMI0886741Medicare ID - Type Unspecified
WV7600021000Medicaid