Provider Demographics
NPI:1508834383
Name:MILLER, MICHEAL J (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHEAL
Middle Name:J
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 1:238 S JEFFERSON AVE
Mailing Address - Street 2:SUITE A.
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-3240
Mailing Address - Country:US
Mailing Address - Phone:417-532-9922
Mailing Address - Fax:417-532-0199
Practice Address - Street 1:238 S JEFFERSON AVE
Practice Address - Street 2:SUITE A.
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-3240
Practice Address - Country:US
Practice Address - Phone:417-532-9922
Practice Address - Fax:417-532-0199
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001008732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT43943Medicare UPIN