Provider Demographics
NPI:1801381140
Name:MILLER, TYLER (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
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:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:CASCADE LOCKS
Mailing Address - State:OR
Mailing Address - Zip Code:97014-0204
Mailing Address - Country:US
Mailing Address - Phone:541-633-8318
Mailing Address - Fax:
Practice Address - Street 1:455 NW WANAPA ST
Practice Address - Street 2:
Practice Address - City:CASCADE LOCKS
Practice Address - State:OR
Practice Address - Zip Code:97014
Practice Address - Country:US
Practice Address - Phone:541-374-0037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5913111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician