Provider Demographics
NPI:1194859546
Name:MILLER, MICHAEL BRUCE (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRUCE
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 1:325 READING AVE
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49250-9427
Mailing Address - Country:US
Mailing Address - Phone:517-849-7911
Mailing Address - Fax:517-849-7912
Practice Address - Street 1:325 READING AVE
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:MI
Practice Address - Zip Code:49250-9427
Practice Address - Country:US
Practice Address - Phone:517-849-7911
Practice Address - Fax:517-849-7912
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007645111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI4397Medicare PIN