Provider Demographics
NPI:1922147495
Name:MILLER, DOUGLAS C (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:C
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 1:3739 WILKENS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5035
Mailing Address - Country:US
Mailing Address - Phone:410-646-2222
Mailing Address - Fax:410-646-2502
Practice Address - Street 1:3739 WILKENS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5035
Practice Address - Country:US
Practice Address - Phone:410-646-2222
Practice Address - Fax:410-646-2502
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD373QMedicare ID - Type Unspecified