Healthcare Provider Details

I. General information

NPI: 1851492243
Provider Name (Legal Business Name): JONATHAN DAVID MILLER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3653 LINDSAY RD
EVERSON WA
98247-9250
US

IV. Provider business mailing address

2015 BRIDGEWAY STE 304
SAUSALITO CA
94965-1787
US

V. Phone/Fax

Practice location:
  • Phone: 415-971-9531
  • Fax:
Mailing address:
  • Phone: 415-331-5274
  • Fax: 415-373-4193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH61519810
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: