Provider Demographics
NPI:1780173393
Name:MILLER, JORDAN TYLER (DC)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:TYLER
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 1:4016 RIVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-6673
Mailing Address - Country:US
Mailing Address - Phone:843-742-7922
Mailing Address - Fax:
Practice Address - Street 1:4016 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-6673
Practice Address - Country:US
Practice Address - Phone:843-742-7922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor