Healthcare Provider Details

I. General information

NPI: 1023073202
Provider Name (Legal Business Name): JUSTIN TODD MILLER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 GRANDVIEW AVE
CHICORA PA
16025-2136
US

IV. Provider business mailing address

109 GRANDVIEW AVENUE
CHICORA PA
16025
US

V. Phone/Fax

Practice location:
  • Phone: 724-607-1160
  • Fax: 724-607-1161
Mailing address:
  • Phone: 724-607-1160
  • Fax: 724-607-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC008931
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number3905
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: