Provider Demographics
NPI:1467403824
Name:MILLER, CLINT D (DC)
Entity Type:Individual
Prefix:DR
First Name:CLINT
Middle Name:D
Last Name:MILLER
Suffix:
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 1:11761 BEACH BLVD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-6615
Mailing Address - Country:US
Mailing Address - Phone:904-642-3304
Mailing Address - Fax:904-928-3561
Practice Address - Street 1:11761 BEACH BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-6615
Practice Address - Country:US
Practice Address - Phone:904-642-3304
Practice Address - Fax:904-928-3561
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6086111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL051010600Medicaid
FL22429Medicare ID - Type Unspecified
FL051010600Medicaid