Provider Demographics
NPI:1780185652
Name:MILLER, DUSTIN DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:DOUGLAS
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 1:401 CENTER AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5904
Mailing Address - Country:US
Mailing Address - Phone:989-778-2522
Mailing Address - Fax:989-778-2523
Practice Address - Street 1:401 CENTER AVE STE 200
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-5904
Practice Address - Country:US
Practice Address - Phone:989-778-2522
Practice Address - Fax:989-778-2523
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010576111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor