Provider Demographics
NPI:1841398682
Name:MILLER, RYAN WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:WILLIAM
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 1:44476 HAYES ROAD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1090
Mailing Address - Country:US
Mailing Address - Phone:586-263-7300
Mailing Address - Fax:
Practice Address - Street 1:44476 HAYES RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-1090
Practice Address - Country:US
Practice Address - Phone:586-263-7300
Practice Address - Fax:586-263-7207
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008510111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E014660OtherBCBS
MI950E014660OtherBCBS
MI0N78700Medicare ID - Type Unspecified