=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528373982
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILLER CHIROPRACTIC WELLNESS CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2010
-----------------------------------------------------
Last Update Date | 04/29/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22 S MAIN ST
-----------------------------------------------------
City | PLEASANTVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08232-2728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-383-9121
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22 S MAIN ST
-----------------------------------------------------
City | PLEASANTVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08232-2728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-383-9121
-----------------------------------------------------
Fax | 609-383-9107
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. THOMAS H MILLER
-----------------------------------------------------
Credential | D.C
-----------------------------------------------------
Telephone | 609-383-9121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 38MC2507
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------