=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104962877
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREGORY JON MILLER D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2007
-----------------------------------------------------
Last Update Date | 05/02/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7000 VILLAGE PKWY SUITE H
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94568-2413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-829-5040
-----------------------------------------------------
Fax | 925-829-5041
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7000 VILLAGE PKWY SUITE H
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94568-2413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-829-5040
-----------------------------------------------------
Fax | 925-829-5041
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC-30323
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------