Provider Demographics
NPI:1558785832
Name:MILLER, SAMANTHA JO
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7284 DOVE ST
Mailing Address - Street 2:
Mailing Address - City:BREEZY POINT
Mailing Address - State:MN
Mailing Address - Zip Code:56472-6746
Mailing Address - Country:US
Mailing Address - Phone:218-343-4198
Mailing Address - Fax:
Practice Address - Street 1:7284 DOVE ST
Practice Address - Street 2:
Practice Address - City:BREEZY POINT
Practice Address - State:MN
Practice Address - Zip Code:56472-6746
Practice Address - Country:US
Practice Address - Phone:218-343-4198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13067611111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation