Healthcare Provider Details

I. General information

NPI: 1588856868
Provider Name (Legal Business Name): ALLEN SCOTT MILLER D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 04/20/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 S JONES BLVD # 1454
LAS VEGAS NV
89107-2623
US

IV. Provider business mailing address

304 S JONES BLVD # 1454
LAS VEGAS NV
89107-2623
US

V. Phone/Fax

Practice location:
  • Phone: 626-399-6834
  • Fax: 626-399-6834
Mailing address:
  • Phone: 626-399-6834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number19031
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number19031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: