Provider Demographics
NPI:1467545533
Name:MILLER, JAY MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:MICHAEL
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 1:2790 W CHURCH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-2860
Mailing Address - Country:US
Mailing Address - Phone:985-429-0005
Mailing Address - Fax:985-429-0018
Practice Address - Street 1:2790 W CHURCH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2860
Practice Address - Country:US
Practice Address - Phone:985-429-0005
Practice Address - Fax:985-429-0018
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA1039111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAU54834Medicare UPIN
LA5T657Medicare PIN