Provider Demographics
NPI:1609142322
Name:MILLER, NICHOLAS R (DC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
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 1:1163 RAMEYS RUN CT
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-5008
Mailing Address - Country:US
Mailing Address - Phone:614-833-0563
Mailing Address - Fax:614-833-0916
Practice Address - Street 1:7344 FODOR RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8336
Practice Address - Country:US
Practice Address - Phone:614-832-8286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor