Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 006395 | GA |
NPI | 1083836977 |
---|---|
Provider Name | Mr. Jeffrey Todd Miller |
First Address | Winder, GA 30680 |
Second Address | Winder, GA 30680 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |