Provider Demographics
NPI:1336456078
Name:MILLER, MARIO B SR (DC)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:B
Last Name:MILLER
Suffix:SR
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 1:50 BARRETT PARKWAY
Mailing Address - Street 2:SUITE 3005#126
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066
Mailing Address - Country:US
Mailing Address - Phone:678-508-6189
Mailing Address - Fax:770-693-0191
Practice Address - Street 1:50 BARRETT PARKWAY
Practice Address - Street 2:SUITE 3005#126
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066
Practice Address - Country:US
Practice Address - Phone:678-508-6189
Practice Address - Fax:770-693-0191
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor