Provider Demographics
NPI:1952329278
Name:MILLER, CLYDE A (DC)
Entity Type:Individual
Prefix:
First Name:CLYDE
Middle Name:A
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 1:3701 FREDERICA ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-6975
Mailing Address - Country:US
Mailing Address - Phone:270-683-9551
Mailing Address - Fax:270-685-2225
Practice Address - Street 1:3701 FREDERICA ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-6975
Practice Address - Country:US
Practice Address - Phone:270-683-9551
Practice Address - Fax:270-685-2225
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYU41769Medicare UPIN
KY6065501Medicare ID - Type Unspecified