Provider Demographics
NPI:1558461475
Name:MILLER, JAMES R (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
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 1:6986 EL CAMINO REAL STE F
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-4111
Mailing Address - Country:US
Mailing Address - Phone:760-438-9548
Mailing Address - Fax:760-438-1603
Practice Address - Street 1:6986 EL CAMINO REAL STE F
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-4111
Practice Address - Country:US
Practice Address - Phone:760-438-9548
Practice Address - Fax:760-438-1603
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT18727Medicare UPIN