Provider Demographics
NPI:1215038500
Name:MILLER, JASON DONALD (DC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DONALD
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 1:1228 66TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-6226
Mailing Address - Country:US
Mailing Address - Phone:727-384-6168
Mailing Address - Fax:727-384-6158
Practice Address - Street 1:1228 66TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-6226
Practice Address - Country:US
Practice Address - Phone:727-384-6168
Practice Address - Fax:727-384-6158
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8123111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL60949OtherBCBS
FLK9133OtherMEDICARE PTAN
FL382042400Medicaid
FL382042400Medicaid