Provider Demographics
NPI:1598799652
Name:MILLER, CARLA (DC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:WEBSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:10 CHARLES ST # A
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2406
Mailing Address - Country:US
Mailing Address - Phone:770-873-5549
Mailing Address - Fax:862-300-3570
Practice Address - Street 1:525 IRVINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07106-3150
Practice Address - Country:US
Practice Address - Phone:862-930-5791
Practice Address - Fax:862-300-3570
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00703300111N00000X
GACHIR007233111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA204272012OtherEIN