Provider Demographics
NPI:1144218678
Name:MILLER, PAUL MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MARK
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 1:515 W FRANCIS AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6413
Mailing Address - Country:US
Mailing Address - Phone:509-328-8269
Mailing Address - Fax:509-327-3649
Practice Address - Street 1:515 W FRANCIS AVE
Practice Address - Street 2:STE 1
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6413
Practice Address - Country:US
Practice Address - Phone:509-328-8269
Practice Address - Fax:509-327-3649
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0048359OtherDEPT LABOR & INDUSTRY WOR
350034609OtherRAILROAD MEDICARE
WAT06216Medicare UPIN
G000304873Medicare ID - Type Unspecified
350034609OtherRAILROAD MEDICARE