Provider Demographics
NPI:1508943937
Name:MILLER, JOLENA M (DC)
Entity Type:Individual
Prefix:DR
First Name:JOLENA
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JOLENA
Other - Middle Name:M
Other - Last Name:SCHUBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:450 E MARKET ST
Mailing Address - Street 2:STE. A
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-1708
Mailing Address - Country:US
Mailing Address - Phone:419-447-0102
Mailing Address - Fax:419-447-0112
Practice Address - Street 1:450 E MARKET ST
Practice Address - Street 2:STE. A
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-1708
Practice Address - Country:US
Practice Address - Phone:419-447-0102
Practice Address - Fax:419-447-0112
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3345111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSC4100704Medicare UPIN