Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4487 | TX |
NPI | 1003980954 |
---|---|
Provider Name | John D Miller |
First Address | San Antonio, TX 78221-1619 |
Second Address | San Antonio, TX 78221-1619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 08/07/2007 |