Provider Demographics
NPI:1023073202
Name:MILLER, JUSTIN TODD (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:TODD
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 1:109 GRANDVIEW AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHICORA
Mailing Address - State:PA
Mailing Address - Zip Code:16025
Mailing Address - Country:US
Mailing Address - Phone:724-607-1160
Mailing Address - Fax:724-607-1161
Practice Address - Street 1:107 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:CHICORA
Practice Address - State:PA
Practice Address - Zip Code:16025-2136
Practice Address - Country:US
Practice Address - Phone:724-607-1160
Practice Address - Fax:724-607-1161
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008931111N00000X
IA3905111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001444553OtherHIGHMARK BLUE SHIELD
PA410093OtherHEALTH AMERICA/HEALTH ASS
PA7645493OtherAETNA
PA5670386OtherCIGNA HEALTHCARE
PAU93621Medicare UPIN
PA065642Medicare ID - Type Unspecified