Healthcare Provider Details

I. General information

NPI: 1194965079
Provider Name (Legal Business Name): JASON EVERETT MILLER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 COLUMBUS AVE STE 206
SAN FRANCISCO CA
94111-2100
US

IV. Provider business mailing address

21 COLUMBUS AVE STE 206
SAN FRANCISCO CA
94111-2100
US

V. Phone/Fax

Practice location:
  • Phone: 415-373-3897
  • Fax: 866-543-9129
Mailing address:
  • Phone: 415-373-3897
  • Fax: 866-543-9129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number30948
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number6126
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: