Provider Demographics
NPI:1497841340
Name:MILJOUR, DAVID VERNON (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:VERNON
Last Name:MILJOUR
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 1566
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443-1566
Mailing Address - Country:US
Mailing Address - Phone:304-876-2230
Mailing Address - Fax:304-876-3943
Practice Address - Street 1:51 MADDEX DR
Practice Address - Street 2:MADDEX PROFESSIONAL CENTER
Practice Address - City:SHEPHERDSTOWN
Practice Address - State:WV
Practice Address - Zip Code:25443
Practice Address - Country:US
Practice Address - Phone:304-876-2230
Practice Address - Fax:304-876-3943
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV490111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131461000Medicaid
WV0131461000Medicaid
WVMI0683521Medicare ID - Type Unspecified