Healthcare Provider Details

I. General information

NPI: 1962577221
Provider Name (Legal Business Name): COLUMBIA MILLER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 05/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 SPRING ST
MONROE NY
10950-3673
US

IV. Provider business mailing address

154 SPRING ST
MONROE NY
10950-3673
US

V. Phone/Fax

Practice location:
  • Phone: 845-781-7813
  • Fax: 845-781-8125
Mailing address:
  • Phone: 845-781-7813
  • Fax: 845-781-8125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX-005905
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberX-005905
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberX-005905
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberX-005905
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: