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General NPI Number Information
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NPI Number | 1720170517
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Entity Type | Individual
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Provider Name | JESSE GLENN MILLER DC
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Gender | Male
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 300 W SHAWNEE ST STE B
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City | MUSKOGEE
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State | OK
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Zip | 74401-4151
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Country | US
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Telephone | 918-683-9777
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Fax | 918-683-9778
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Provider Business Mailing Address
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Address Line | 300 W SHAWNEE ST STE B
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City | MUSKOGEE
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State | OK
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Zip | 74401-4151
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Country | US
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Telephone | 918-683-9777
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Fax | 918-683-9778
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3042
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License Number State | OK
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