Provider Demographics
NPI:1073696621
Name:MILLER, GREGORY (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
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 1:5308 PARKLANE DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8630
Mailing Address - Country:US
Mailing Address - Phone:308-237-0648
Mailing Address - Fax:308-236-9197
Practice Address - Street 1:5308 PARKLANE DR
Practice Address - Street 2:SUITE 5
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8630
Practice Address - Country:US
Practice Address - Phone:308-237-0648
Practice Address - Fax:308-236-9197
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE232852OtherMIDLANDS CHOICE
NE470835470-00Medicaid
NE99502OtherBLU CROSS BLUE SHIELD
NE99502OtherBLU CROSS BLUE SHIELD
NE470835470-00Medicaid