Provider Demographics
NPI:1821393224
Name:MILLER, ERIC DEAN (LAC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:DEAN
Last Name:MILLER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WILSHIRE BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1883
Mailing Address - Country:US
Mailing Address - Phone:310-913-1317
Mailing Address - Fax:310-434-2424
Practice Address - Street 1:900 WILSHIRE BLVD STE 315
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1883
Practice Address - Country:US
Practice Address - Phone:310-913-1317
Practice Address - Fax:310-434-2424
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9235171100000X
CAAC 9235133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No133N00000XDietary & Nutritional Service ProvidersNutritionist