Healthcare Provider Details

I. General information

NPI: 1467403824
Provider Name (Legal Business Name): CLINT D. MILLER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11761 BEACH BLVD SUITE 8
JACKSONVILLE FL
32246-6615
US

IV. Provider business mailing address

11761 BEACH BLVD SUITE 8
JACKSONVILLE FL
32246-6615
US

V. Phone/Fax

Practice location:
  • Phone: 904-642-3304
  • Fax: 904-928-3561
Mailing address:
  • Phone: 904-642-3304
  • Fax: 904-928-3561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH6086
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: