Provider Demographics
NPI:1659377364
Name:MILLER, MARK ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
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 1:1745 W HUNT HWY
Mailing Address - Street 2:STE. 103
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-5215
Mailing Address - Country:US
Mailing Address - Phone:480-677-3702
Mailing Address - Fax:480-677-3724
Practice Address - Street 1:1745 W HUNT HWY
Practice Address - Street 2:STE. 103
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85143-5215
Practice Address - Country:US
Practice Address - Phone:480-677-3702
Practice Address - Fax:480-677-3724
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5574111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ00033731OtherBANNER HEALTHCARE
AZAZ0938560OtherBCBS OF AZ
AZU62544Medicare UPIN
AZZ75700Medicare PIN
AZZ75700Medicare Oscar/Certification