Provider Demographics
NPI:1134139520
Name:MILLER, FRED A (DC)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:A
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 1:1796 W CAUSEWAY APPROACH
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-2955
Mailing Address - Country:US
Mailing Address - Phone:985-626-1671
Mailing Address - Fax:985-624-4984
Practice Address - Street 1:1796 W CAUSEWAY APPROACH
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-2955
Practice Address - Country:US
Practice Address - Phone:985-626-1671
Practice Address - Fax:985-624-4984
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAT19892Medicare UPIN
LA59041Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER