Provider Demographics
NPI:1336173798
Name:MILLER, JOHN THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
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 1:2220 HIGHWAY 45 N
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-2709
Mailing Address - Country:US
Mailing Address - Phone:601-482-7300
Mailing Address - Fax:601-482-7380
Practice Address - Street 1:2220 HIGHWAY 45 N
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-2709
Practice Address - Country:US
Practice Address - Phone:601-482-7300
Practice Address - Fax:601-482-7380
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120379Medicaid
MS640904421OtherTAX ID
MSP00173337Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MS350000233Medicare ID - Type Unspecified
MS640904421OtherTAX ID