Provider Demographics
NPI:1295725232
Name:MILLER, SUSAN DENISE (DC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:DENISE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PECAN CRK
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6372
Mailing Address - Country:US
Mailing Address - Phone:817-442-8554
Mailing Address - Fax:817-442-8573
Practice Address - Street 1:200 PECAN CRK
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6372
Practice Address - Country:US
Practice Address - Phone:817-442-8554
Practice Address - Fax:817-442-8573
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX618918OtherUNITED HEALTHCARE
TX606222OtherBLUE CROSS BLUE SHIELD
TX606222OtherBLUE CROSS BLUE SHIELD