Provider Demographics
NPI:1225251366
Name:MILLER CHIROPRACTIC CENTRE INC PSC
Entity Type:Organization
Organization Name:MILLER CHIROPRACTIC CENTRE INC PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DARRYL
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-744-3700
Mailing Address - Street 1:1200 BYPASS RD
Mailing Address - Street 2:STE B
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-2724
Mailing Address - Country:US
Mailing Address - Phone:859-744-3700
Mailing Address - Fax:859-744-3262
Practice Address - Street 1:1200 BYPASS RD
Practice Address - Street 2:STE B
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-2724
Practice Address - Country:US
Practice Address - Phone:859-744-3700
Practice Address - Fax:859-744-3262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4596OtherCHA
KYNA150329Medicaid
KY607451OtherACN
KY5504456OtherAETNA
KY4400065OtherUNITED HEALTH CARE
KY350029303OtherRAIL ROAD MEDICARE
KY000000062838OtherANTHEM
KY6051101Medicare ID - Type Unspecified
KYT78570Medicare UPIN