Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC008931 | PA |
N | 111NS0005X | Chiropractic Sports Physician | 3905 | IA |
NPI | 1023073202 |
---|---|
Provider Name | Dr. Justin Todd Miller |
First Address | Chicora, PA 16025 |
Second Address | Chicora, PA 16025-2136 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 22/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001444553 | HIGHMARK BLUE SHIELD (01) | PA |
410093 | HEALTH AMERICA/HEALTH ASS (01) | PA |
5670386 | CIGNA HEALTHCARE (01) | PA |
7645493 | AETNA (01) | PA |
U93621 | (02) | PA |