=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104183805
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILLER CHIROPRACTIC CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2012
-----------------------------------------------------
Last Update Date | 06/14/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17931 EUCLID ST
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92708-5409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-963-8855
-----------------------------------------------------
Fax | 714-963-5775
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17931 EUCLID ST
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92708-5409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-963-8855
-----------------------------------------------------
Fax | 714-963-5775
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ROBERT FRANCIS MILLER
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 714-963-8855
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number | DC15656
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------