Healthcare Provider Details

I. General information

NPI: 1801381140
Provider Name (Legal Business Name): TYLER MILLER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 NW WANAPA ST
CASCADE LOCKS OR
97014
US

IV. Provider business mailing address

PO BOX 204
CASCADE LOCKS OR
97014-0204
US

V. Phone/Fax

Practice location:
  • Phone: 541-374-0037
  • Fax:
Mailing address:
  • Phone: 541-633-8318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5913
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: