Provider Demographics
NPI:1790871010
Name:MILLER, DWIGHT R (DC)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:R
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 1:202 HIGHLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:PA
Mailing Address - Zip Code:16695
Mailing Address - Country:US
Mailing Address - Phone:814-766-3333
Mailing Address - Fax:814-766-3301
Practice Address - Street 1:202 HIGHLAND DRIVE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:PA
Practice Address - Zip Code:16695
Practice Address - Country:US
Practice Address - Phone:814-766-3333
Practice Address - Fax:814-766-3301
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001740L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350056541OtherRAILROAD MEDICARE
PA01934782Medicaid
PA318570OtherUPMC INSURANCE
3034645OtherCIGNA INSURANCE
PA01934782Medicaid
PA035338Medicare PIN