Provider Demographics
NPI:1831250109
Name:MILLER, JOHN STEPHEN (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:STEPHEN
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 1:9015 HOLMAN RD NW STE 3
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3481
Mailing Address - Country:US
Mailing Address - Phone:206-784-8119
Mailing Address - Fax:206-784-4020
Practice Address - Street 1:9015 HOLMAN RD NW STE 3
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-3481
Practice Address - Country:US
Practice Address - Phone:206-784-8119
Practice Address - Fax:206-784-4020
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002256111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMI8798OtherREGENCE BLUESHIELD
WA0004396929OtherAETNA INSURANCE COMPANY
WA0109247Medicare PIN