Provider Demographics
NPI:1720055338
Name:MILLER, CLARENCE DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:DANIEL
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 1:180 CLAIRTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-3802
Mailing Address - Country:US
Mailing Address - Phone:412-653-7715
Mailing Address - Fax:412-653-6255
Practice Address - Street 1:180 CLAIRTON BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-3802
Practice Address - Country:US
Practice Address - Phone:412-653-7715
Practice Address - Fax:412-653-6255
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001155L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00636973Medicaid
PA115730KNDMedicare ID - Type Unspecified
PAUO8582Medicare UPIN