Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1154 | OR |
NPI | 1003947235 |
---|---|
Provider Name | Dr. David L Miller |
First Address | Sweet Home, OR 97386-2108 |
Second Address | Sweet Home, OR 97386-2108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Y0399 | PACIFICSOURCE (01) | OR |