Provider Demographics
NPI:1396865630
Name:MILLER CHIROPRACTIC CLINIC PA
Entity Type:Organization
Organization Name:MILLER CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-239-0758
Mailing Address - Street 1:885 CONFERENCE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2082
Mailing Address - Country:US
Mailing Address - Phone:615-239-0758
Mailing Address - Fax:
Practice Address - Street 1:885 CONFERENCE DR STE 300
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2082
Practice Address - Country:US
Practice Address - Phone:615-239-0758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G703687OtherPTAN
KSU70492Medicare UPIN