Provider Demographics
NPI:1932252566
Name:MILLER, GARY STEPHEN (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
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 1:7 E WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2310
Mailing Address - Country:US
Mailing Address - Phone:610-544-6336
Mailing Address - Fax:610-544-7059
Practice Address - Street 1:7 E WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2310
Practice Address - Country:US
Practice Address - Phone:610-544-6336
Practice Address - Fax:610-544-7059
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006703L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2985621OtherAETNA
PA2185534000OtherPERSONAL CHOICE
PA0158097000OtherKEYSTONE
PA2985621OtherAETNA