Provider Demographics
NPI:1578756847
Name:MILLER, MARK W (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:MILLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:9180 US HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1652
Mailing Address - Country:US
Mailing Address - Phone:406-600-7524
Mailing Address - Fax:269-473-6116
Practice Address - Street 1:9180 US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-1652
Practice Address - Country:US
Practice Address - Phone:406-600-7524
Practice Address - Fax:269-473-6116
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT1163111N00000X
NC4571111NI0013X
MI2301009129111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner