Provider Demographics
NPI:1851346456
Name:MILLER, SHAWN W (DC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:W
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 1:608 HUNTER HWY
Mailing Address - Street 2:SUITE 112
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-8068
Mailing Address - Country:US
Mailing Address - Phone:570-836-0558
Mailing Address - Fax:570-836-0588
Practice Address - Street 1:608 HUNTER HWY
Practice Address - Street 2:SUITE 112
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-8068
Practice Address - Country:US
Practice Address - Phone:570-836-0558
Practice Address - Fax:570-836-0588
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
3225134OtherAETNA
813696OtherFIRST PRIORITY
PA0018655130005Medicaid
813696OtherFIRST PRIORITY
3225134OtherAETNA