Provider Demographics
NPI:1649359605
Name:MILLER, MILTON JR (DC)
Entity type:Individual
Prefix:DR
First Name:MILTON
Middle Name:
Last Name:MILLER
Suffix:JR
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 1:2856 VINEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2832
Mailing Address - Country:US
Mailing Address - Phone:478-742-2225
Mailing Address - Fax:478-746-4905
Practice Address - Street 1:2856 VINEVILLE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2832
Practice Address - Country:US
Practice Address - Phone:478-742-2225
Practice Address - Fax:478-746-4905
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO07592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6514OtherGROUP
GA35ZCHSTMedicare ID - Type Unspecified