Provider Demographics
NPI:1134403256
Name:MILLER, DONALD ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ROBERT
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 1:10459 SOUTH 1300 WEST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095
Mailing Address - Country:US
Mailing Address - Phone:385-308-8169
Mailing Address - Fax:
Practice Address - Street 1:10459 SOUTH 1300 WEST
Practice Address - Street 2:SUITE 203
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095
Practice Address - Country:US
Practice Address - Phone:385-308-8169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5307111N00000X
UT1190876-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor