Provider Demographics
NPI:1619247137
Name:MILLER, MARCUS GREG (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:GREG
Last Name:MILLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:MARCUS
Other - Middle Name:GREG
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CEP
Mailing Address - Street 1:621 CRESTGATE PL
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17551-2116
Mailing Address - Country:US
Mailing Address - Phone:717-872-0371
Mailing Address - Fax:
Practice Address - Street 1:621 CRESTGATE PL
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17551-2116
Practice Address - Country:US
Practice Address - Phone:717-872-0371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006282-L111N00000X
PA1000429224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist