Healthcare Provider Details

I. General information

NPI: 1093701724
Provider Name (Legal Business Name): CHARLES C MILLER JR. DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E SPRINGFIELD RD
SPRINGFIELD PA
19064-2541
US

IV. Provider business mailing address

101 E SPRINGFIELD RD
SPRINGFIELD PA
19064-2541
US

V. Phone/Fax

Practice location:
  • Phone: 610-328-5517
  • Fax: 610-328-5526
Mailing address:
  • Phone: 610-328-5517
  • Fax: 610-328-5526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC001459L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: