Provider Demographics
NPI:1497712905
Name:MILLER, GREGORY JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JOHN
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 1:2078 ARMY DR STE C
Mailing Address - Street 2:
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-6521
Mailing Address - Country:US
Mailing Address - Phone:671-637-7926
Mailing Address - Fax:671-637-8887
Practice Address - Street 1:2078 ARMY DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-8521
Practice Address - Country:US
Practice Address - Phone:671-637-7926
Practice Address - Fax:671-637-8887
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUC-3111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUT02761Medicare UPIN