Provider Demographics
NPI:1205053170
Name:MILLER, DAVID CARL (LMP)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CARL
Last Name:MILLER
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2853
Mailing Address - Country:US
Mailing Address - Phone:509-464-2273
Mailing Address - Fax:509-242-1854
Practice Address - Street 1:3809 N MONROE ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2853
Practice Address - Country:US
Practice Address - Phone:509-464-2273
Practice Address - Fax:509-242-1854
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023624225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist