Provider Demographics
NPI:1447201926
Name:MILLER, TARA D (DC)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:D
Last Name:MILLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183 DANIEL ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7508
Mailing Address - Country:US
Mailing Address - Phone:843-471-1909
Mailing Address - Fax:843-553-9731
Practice Address - Street 1:1183 DANIEL ISLAND DR
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7508
Practice Address - Country:US
Practice Address - Phone:843-471-1909
Practice Address - Fax:843-553-9731
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2873Medicaid
SCCH2873Medicaid
SCAA0273Medicare UPIN