Provider Demographics
NPI:1013111269
Name:MILLER CHIROPRACTIC & REHAB, P.A.
Entity type:Organization
Organization Name:MILLER CHIROPRACTIC & REHAB, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-341-3434
Mailing Address - Street 1:4881 FREDERICKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3627
Mailing Address - Country:US
Mailing Address - Phone:210-341-3434
Mailing Address - Fax:210-341-4303
Practice Address - Street 1:4881 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3627
Practice Address - Country:US
Practice Address - Phone:210-341-3434
Practice Address - Fax:210-341-4303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7034111N00000X
TX7315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609017Medicare PIN
TX605499Medicare PIN