Provider Demographics
NPI:1952493074
Name:MILLER, JOHN A (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
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 1:535 LINCOLNWAY WEST
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-1800
Mailing Address - Country:US
Mailing Address - Phone:574-255-2268
Mailing Address - Fax:
Practice Address - Street 1:535 LINCOLNWAY WEST
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-1800
Practice Address - Country:US
Practice Address - Phone:574-255-2268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN508111N00000X
KY3470111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000203589OtherBCBS
T86624Medicare UPIN
000000203589OtherBCBS