Provider Demographics
NPI:1942437702
Name:MILLER, DAVID ALTON (LAC MSTOM)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALTON
Last Name:MILLER
Suffix:
Gender:M
Credentials:LAC MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HONEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06018-2005
Mailing Address - Country:US
Mailing Address - Phone:860-824-9850
Mailing Address - Fax:
Practice Address - Street 1:15 ACADEMY STREET
Practice Address - Street 2:2
Practice Address - City:SALISBURY
Practice Address - State:CT
Practice Address - Zip Code:06068
Practice Address - Country:US
Practice Address - Phone:860-435-2219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238173171100000X
CT000354171100000X
NY003090171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist