Healthcare Provider Details

I. General information

NPI: 1992899587
Provider Name (Legal Business Name): JAMES ROBERT MILLER PT, DC, ECS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 N TRACY BLVD
TRACY CA
95376-3445
US

IV. Provider business mailing address

1423 N TRACY BLVD
TRACY CA
95376-3445
US

V. Phone/Fax

Practice location:
  • Phone: 209-830-8855
  • Fax: 209-830-8837
Mailing address:
  • Phone: 209-830-8855
  • Fax: 209-830-8837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT24991
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC29853
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License NumberPT24991
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: