Provider Demographics
NPI:1235101213
Name:MILLER, JAMES D (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
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 1:214 HWY 61
Mailing Address - Street 2:BOX 78A
Mailing Address - City:MEDIAPOLIS
Mailing Address - State:IA
Mailing Address - Zip Code:52637
Mailing Address - Country:US
Mailing Address - Phone:319-394-9120
Mailing Address - Fax:
Practice Address - Street 1:214 HWY 61
Practice Address - Street 2:BOX 78A
Practice Address - City:MEDIAPOLIS
Practice Address - State:IA
Practice Address - Zip Code:52637
Practice Address - Country:US
Practice Address - Phone:319-394-9120
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
13759Medicare ID - Type Unspecified