Healthcare Provider Details

I. General information

NPI: 1417386384
Provider Name (Legal Business Name): JEFFERY KEVIN MILLER DC, MSC, ATC, CPED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 DEVALL DR
AUBURN AL
36832-5813
US

IV. Provider business mailing address

1262 SHADOWWOOD LN
AUBURN AL
36879-5430
US

V. Phone/Fax

Practice location:
  • Phone: 770-856-5799
  • Fax:
Mailing address:
  • Phone: 770-856-5799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2411
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: