Provider Demographics
NPI:1174656417
Name:MILLER, STEVEN LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LEE
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 1:125 JEFF DAVIS AVE.
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-3632
Mailing Address - Country:US
Mailing Address - Phone:228-868-8885
Mailing Address - Fax:228-868-4991
Practice Address - Street 1:125 JEFF DAVIS AVE.
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-3632
Practice Address - Country:US
Practice Address - Phone:228-868-8885
Practice Address - Fax:228-868-4991
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1174656417Medicare PIN