Provider Demographics
NPI:1134136922
Name:MILLER, MARK CHRISTIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:CHRISTIAN
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 1:4881 FREDERICKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3627
Mailing Address - Country:US
Mailing Address - Phone:210-341-3434
Mailing Address - Fax:210-341-4303
Practice Address - Street 1:4881 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3627
Practice Address - Country:US
Practice Address - Phone:210-341-3434
Practice Address - Fax:210-341-4303
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609017Medicare ID - Type Unspecified
TXU68608Medicare UPIN