Provider Demographics
NPI:1124192398
Name:MILLER, JASON NICHOLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:NICHOLAS
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 1:1237 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-7237
Mailing Address - Country:US
Mailing Address - Phone:508-226-2333
Mailing Address - Fax:508-226-2421
Practice Address - Street 1:1237 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-7237
Practice Address - Country:US
Practice Address - Phone:508-226-2333
Practice Address - Fax:508-226-2421
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00479111N00000X
MA2643111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA6349OtherHARVARD PILGRIM
MA478866OtherTUFTS
RI80478-5OtherBLUE CROSS RI
MAY36835OtherBLUE CROSS MA
MA4400958OtherUNITED HEALTH
MA1601228Medicaid
MA409235OtherBLUE CHIP
MAU88228Medicare UPIN
MA478866OtherTUFTS