Provider Demographics
NPI:1912071788
Name:MILLER, ANTHONY JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JASON
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:PO BOX 311
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63302-0311
Mailing Address - Country:US
Mailing Address - Phone:314-496-5884
Mailing Address - Fax:
Practice Address - Street 1:12855 N 40 DR STE 380
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8663
Practice Address - Country:US
Practice Address - Phone:314-682-6448
Practice Address - Fax:314-434-4775
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000149072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor