Provider Demographics
NPI:1205900784
Name:MILLER, CHARLES T JR (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:T
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4070 N BELT LINE RD
Mailing Address - Street 2:# 164
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-5043
Mailing Address - Country:US
Mailing Address - Phone:972-258-6223
Mailing Address - Fax:972-258-0478
Practice Address - Street 1:4070 N BELT LINE RD
Practice Address - Street 2:# 164
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-5043
Practice Address - Country:US
Practice Address - Phone:972-258-6223
Practice Address - Fax:972-258-0478
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU26729Medicare UPIN
TX606690Medicare ID - Type Unspecified