Healthcare Provider Details

I. General information

NPI: 1871190991
Provider Name (Legal Business Name): JORDAN WAYNE MILLER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 10/01/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11876 OLIO RD STE 500
FISHERS IN
46037-9772
US

IV. Provider business mailing address

11242 WOLF DANCER PASS S BLDG 27-302
FISHERS IN
46037-4741
US

V. Phone/Fax

Practice location:
  • Phone: 317-595-9620
  • Fax: 317-595-9630
Mailing address:
  • Phone: 317-450-3214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08003185A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: