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General NPI Number Information
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NPI Number | 1801912548
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Entity Type | Organization
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Legal Business Name | MILLER CHIROPRACTIC
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 936 12TH PL STE A
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City | PRESCOTT
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State | AZ
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Zip | 86305-1436
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Country | US
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Telephone | 928-776-0321
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Fax | 928-776-0014
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Provider Business Mailing Address
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Address Line | 936 12TH PL STE A
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City | PRESCOTT
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State | AZ
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Zip | 86305-1436
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Country | US
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Telephone | 928-776-0321
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Fax | 928-776-0014
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. MARK EDWARD MILLER
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Credential | DC
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Telephone | 928-776-9958
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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 | 6016
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License Number State | AZ
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