Provider Demographics
NPI:1689903270
Name:BRAD MILLER CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:BRAD MILLER CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:BRAD
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:626-930-1355
Mailing Address - Street 1:212 E FOOTHILL BLVD
Mailing Address - Street 2:STE. C
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-2527
Mailing Address - Country:US
Mailing Address - Phone:626-930-1355
Mailing Address - Fax:626-930-1354
Practice Address - Street 1:212 E FOOTHILL BLVD
Practice Address - Street 2:STE. C
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-2527
Practice Address - Country:US
Practice Address - Phone:626-930-1355
Practice Address - Fax:626-930-1354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16749111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC16749Medicare UPIN