Provider Demographics
NPI:1871190991
Name:MILLER, JORDAN WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:WAYNE
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 1:11242 WOLF DANCER PASS S BLDG 27-302
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-4741
Mailing Address - Country:US
Mailing Address - Phone:317-450-3214
Mailing Address - Fax:
Practice Address - Street 1:11876 OLIO RD STE 500
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9772
Practice Address - Country:US
Practice Address - Phone:317-595-9620
Practice Address - Fax:317-595-9630
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003185A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor