Provider Demographics
NPI:1841308368
Name:MILLER, LARRY J (DC)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:J
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 1:803 W IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3807
Mailing Address - Country:US
Mailing Address - Phone:714-990-4433
Mailing Address - Fax:714-990-6510
Practice Address - Street 1:803 W IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3807
Practice Address - Country:US
Practice Address - Phone:714-990-4433
Practice Address - Fax:714-990-6510
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11782111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC11782Medicare UPIN