Provider Demographics
NPI:1518987866
Name:MILLER, TREVOR CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:CHARLES
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 1:209 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-1818
Mailing Address - Country:US
Mailing Address - Phone:812-346-1757
Mailing Address - Fax:812-346-3595
Practice Address - Street 1:209 S STATE ST
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-1818
Practice Address - Country:US
Practice Address - Phone:812-346-1757
Practice Address - Fax:812-346-3595
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001640111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200087390AMedicaid
IN255420AMedicare PIN
IN605690AMedicare PIN