Provider Demographics
NPI:1982621314
Name:MILLER CHIROPRACTIC AND WELLNESS INC
Entity Type:Organization
Organization Name:MILLER CHIROPRACTIC AND WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-384-6168
Mailing Address - Street 1:1228 66TH STREET N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-6226
Mailing Address - Country:US
Mailing Address - Phone:727-384-6168
Mailing Address - Fax:727-384-6158
Practice Address - Street 1:1228 66TH STREET N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-6226
Practice Address - Country:US
Practice Address - Phone:727-384-6168
Practice Address - Fax:727-384-6158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8123111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL382042400Medicaid
FLK9133OtherMEDICARE PTAN
FL60949OtherBCBS
FL60949OtherBCBS