Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NS0005X | Chiropractic Sports Physician | 19031 | CA |
Y | 111NX0100X | Occupational Health | 19031 | CA |
NPI | 1588856868 |
---|---|
Provider Name | Dr. Allen Scott Miller |
First Address | Las Vegas, NV 89107-2623 |
Second Address | Las Vegas, NV 89107-2623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2007 |
Last Update Date | 20/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
19031 | STATE LICENCE (01) | CA |