Provider Demographics
NPI:1609825835
Name:MILLER, JARED ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:ALAN
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 1:3688 E CAMPUS DR
Mailing Address - Street 2:STE 110
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-4668
Mailing Address - Country:US
Mailing Address - Phone:801-789-5416
Mailing Address - Fax:801-768-3237
Practice Address - Street 1:3688 CAMPUS DR
Practice Address - Street 2:SUITE 110
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84043-4718
Practice Address - Country:US
Practice Address - Phone:801-789-5416
Practice Address - Fax:801-768-3237
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-06
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5253845-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870395551005Medicaid
UT74-3079413OtherTAX ID
UTHT 002456-001OtherTPN
UTHT 002456-001OtherTPN
UT000056331Medicare ID - Type Unspecified