Healthcare Provider Details

I. General information

NPI: 1649698564
Provider Name (Legal Business Name): MILLER FAMILY CHIROPRACTIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2014
Last Update Date: 03/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 COLONY CROSSING WAY SUITE 700
MADISON MS
39110-6322
US

IV. Provider business mailing address

119 COLONY CROSSING WAY SUITE 700
MADISON MS
39110-6322
US

V. Phone/Fax

Practice location:
  • Phone: 601-898-0456
  • Fax: 601-898-0466
Mailing address:
  • Phone: 601-898-0456
  • Fax: 601-898-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1117
License Number StateMS

VIII. Authorized Official

Name: DR. JAMES RYAN MILLER
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 601-898-0456