Healthcare Provider Details

I. General information

NPI: 1780173393
Provider Name (Legal Business Name): JORDAN TYLER MILLER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 HIGHWAY 17 N STE 106
NORTH MYRTLE BEACH SC
29582-8107
US

IV. Provider business mailing address

211 HIGHWAY 17 N STE 106
NORTH MYRTLE BEACH SC
29582-8107
US

V. Phone/Fax

Practice location:
  • Phone: 843-251-9526
  • Fax:
Mailing address:
  • Phone: 843-251-9526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4332
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: