Provider Demographics
NPI:1225672116
Name:MILLER, JORDAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 ROAD TO SIX FLAGS ST E STE 103
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-5044
Mailing Address - Country:US
Mailing Address - Phone:817-461-2697
Mailing Address - Fax:
Practice Address - Street 1:1201 ROAD TO SIX FLAGS ST E STE 103
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5044
Practice Address - Country:US
Practice Address - Phone:817-461-2697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor