Healthcare Provider Details

I. General information

NPI: 1508834383
Provider Name (Legal Business Name): MICHEAL J. MILLER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 S JEFFERSON AVE SUITE A.
LEBANON MO
65536-3240
US

IV. Provider business mailing address

238 S JEFFERSON AVE SUITE A.
LEBANON MO
65536-3240
US

V. Phone/Fax

Practice location:
  • Phone: 417-532-9922
  • Fax: 417-532-0199
Mailing address:
  • Phone: 417-532-9922
  • Fax: 417-532-0199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2001008732
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: