Provider Demographics
NPI:1417386384
Name:MILLER, JEFFERY KEVIN (DC, MSC, ATC, CPED)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:KEVIN
Last Name:MILLER
Suffix:
Gender:M
Credentials:DC, MSC, ATC, CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1262 SHADOWWOOD LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36879-5430
Mailing Address - Country:US
Mailing Address - Phone:770-856-5799
Mailing Address - Fax:
Practice Address - Street 1:560 DEVALL DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36832-5813
Practice Address - Country:US
Practice Address - Phone:770-856-5799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2411111NR0400X
172M00000X, 1744R1102X, 224L00000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No172M00000XOther Service ProvidersMechanotherapist
No1744R1102XOther Service ProvidersSpecialistResearch Study
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer