Provider Demographics
NPI:1114088119
Name:MILLER, PAUL ROBBIE (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ROBBIE
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 1:300 VIRGINIA RD STE D
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-9553
Mailing Address - Country:US
Mailing Address - Phone:252-482-4499
Mailing Address - Fax:252-482-1077
Practice Address - Street 1:300 VIRGINIA RD STE D
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-9553
Practice Address - Country:US
Practice Address - Phone:252-482-4499
Practice Address - Fax:252-482-1077
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2452919AMedicare ID - Type Unspecified