MEDICARE: MR. DANIEL JAMES MILLER ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	2101	MN

General Provider Information

NPI Number	:	1659513331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL JAMES MILLER ATC

Provider Business Mailing Address
First Line	:	85 PLEASANT DR
Second Line	:
City	:	HASTINGS
State	:	MN
Zip	:	55033-1648
Country	:	US
Telephone Number	:	651-480-4168
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 GENERAL SIEBEN DR
Second Line	:
City	:	HASTINGS
State	:	MN
Zip	:	55033-2486
Country	:	US
Telephone Number	:	651-480-0205
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2009
Last Update Date	:	03/27/2009

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