Provider Demographics
NPI:1487865531
Name:MILLER, ROGER A (DC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:A
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:PO BOX 25081
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27114-5081
Mailing Address - Country:US
Mailing Address - Phone:336-659-0655
Mailing Address - Fax:
Practice Address - Street 1:1495 RYMCO DR
Practice Address - Street 2:SUITE 107
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2947
Practice Address - Country:US
Practice Address - Phone:336-659-0655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1717111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908629Medicaid
NC8981OtherPARTNERS INSURANCE NUMBER
NC08629OtherBCBS NUMBER
NC8981OtherPARTNERS INSURANCE NUMBER
NC8908629Medicaid