Provider Demographics
NPI:1083836977
Name:MILLER, JEFFREY TODD (DC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:TODD
Last Name:MILLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:257 N. BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680
Mailing Address - Country:US
Mailing Address - Phone:770-307-0873
Mailing Address - Fax:770-307-3558
Practice Address - Street 1:257 N. BROAD STREET
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680
Practice Address - Country:US
Practice Address - Phone:770-307-0873
Practice Address - Fax:770-307-3558
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006395111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGROMedicare ID - Type UnspecifiedMEDICARE NUMBER