Provider Demographics
NPI:1649294919
Name:MINER, DAVID JOSEPH (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOSEPH
Last Name:MINER
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 1:16320 TISH-A-TANG RD
Mailing Address - Street 2:
Mailing Address - City:LOWER LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95457-0815
Mailing Address - Country:US
Mailing Address - Phone:707-994-5204
Mailing Address - Fax:707-994-7924
Practice Address - Street 1:16320 TISHATANG RD
Practice Address - Street 2:
Practice Address - City:LOWER LAKE
Practice Address - State:CA
Practice Address - Zip Code:95457-0815
Practice Address - Country:US
Practice Address - Phone:707-994-5204
Practice Address - Fax:707-994-7924
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0214440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19129Medicare UPIN