Healthcare Provider Details

I. General information

NPI: 1700179173
Provider Name (Legal Business Name): MILLER SPORTS & FAMILY CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 05/18/2011
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 Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC008931
License Number StatePA

VIII. Authorized Official

Name: DR. JUSTIN TODD MILLER
Title or Position: OWNER
Credential: D.C.
Phone: 724-607-1160