Provider Demographics
NPI:1760796239
Name:MILLER, HEITH A (DC)
Entity Type:Individual
Prefix:DR
First Name:HEITH
Middle Name:A
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 1:1901 JESS PARRISH CT
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2146
Mailing Address - Country:US
Mailing Address - Phone:321-268-1999
Mailing Address - Fax:321-264-2440
Practice Address - Street 1:1901 JESS PARRISH CT
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2146
Practice Address - Country:US
Practice Address - Phone:321-268-1999
Practice Address - Fax:321-264-2440
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4103111N00000X
GA8729111N00000X
VA0104556937111N00000X
FLCH10967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015331900Medicaid
FLIF771ZOtherMEDICARE PTAN