Provider Demographics
NPI:1376670703
Name:GLENN C. MILLER CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:GLENN C. MILLER CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:CLIFFORD
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-542-4778
Mailing Address - Street 1:3637 LARCH AVE
Mailing Address - Street 2:STE. 1
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-8448
Mailing Address - Country:US
Mailing Address - Phone:530-542-4778
Mailing Address - Fax:
Practice Address - Street 1:3637 LARCH AVE
Practice Address - Street 2:STE. 1
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-8448
Practice Address - Country:US
Practice Address - Phone:530-542-4778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty