Provider Demographics
NPI:1235325184
Name:MILLER CHIROPRACTIC OFFICE, INC
Entity Type:Organization
Organization Name:MILLER CHIROPRACTIC OFFICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:606-862-6986
Mailing Address - Street 1:2619 COUNTY FARM RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-8336
Mailing Address - Country:US
Mailing Address - Phone:606-862-6986
Mailing Address - Fax:606-862-6347
Practice Address - Street 1:2619 COUNTY FARM RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-8336
Practice Address - Country:US
Practice Address - Phone:606-862-6986
Practice Address - Fax:606-862-6347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2010-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85001972Medicaid
KY85001972Medicaid