Basic Information
Provider Information
NPI: 1558461475
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MILLER
FirstName: JAMES
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: DC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6986 EL CAMINO REAL STE F
Address2:  
City: CARLSBAD
State: CA
PostalCode: 920094111
CountryCode: US
TelephoneNumber: 7604389548
FaxNumber: 7604381603
Practice Location
Address1: 6986 EL CAMINO REAL STE F
Address2:  
City: CARLSBAD
State: CA
PostalCode: 920094111
CountryCode: US
TelephoneNumber: 7604389548
FaxNumber: 7604381603
Other Information
ProviderEnumerationDate: 09/22/2006
LastUpdateDate: 07/09/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
111N00000XDC18888CAY Chiropractic ProvidersChiropractor 

No ID Information.


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