Provider Demographics
NPI:1124041835
Name:MILLER, CARL DANA (DC)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:DANA
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 1:41074 7 MILE RD
Mailing Address - Street 2:A
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-2669
Mailing Address - Country:US
Mailing Address - Phone:248-348-3500
Mailing Address - Fax:248-348-1066
Practice Address - Street 1:41074 7 MILE RD
Practice Address - Street 2:A
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2669
Practice Address - Country:US
Practice Address - Phone:248-348-3500
Practice Address - Fax:248-348-1066
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICM005002111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Q25009Medicare ID - Type Unspecified