Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 1163 | MT |
Y | 111N00000X | Chiropractor | 2301009129 | MI |
N | 111NI0013X | Independent Medical Examiner | 4571 | NC |
NPI | 1578756847 |
---|---|
Provider Name | Dr. Mark W. Miller |
First Address | Berrien Springs, MI 49103-1652 |
Second Address | Berrien Springs, MI 49103-1652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2007 |
Last Update Date | 01/05/2017 |