Healthcare Provider Details

I. General information

NPI: 1225672116
Provider Name (Legal Business Name): JORDAN MILLER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1201 ROAD TO SIX FLAGS ST E STE 103
ARLINGTON TX
76011-5044
US

IV. Provider business mailing address

1201 ROAD TO SIX FLAGS ST E STE 103
ARLINGTON TX
76011-5044
US

V. Phone/Fax

Practice location:
  • Phone: 817-461-2697
  • Fax:
Mailing address:
  • Phone: 817-461-2697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number14266
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: