Provider Demographics
NPI:1902958606
Name:MILLER, TONYA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:TONYA
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 ARABIAN AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-8207
Mailing Address - Country:US
Mailing Address - Phone:701-221-2636
Mailing Address - Fax:701-221-2637
Practice Address - Street 1:2911 N 14TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0659
Practice Address - Country:US
Practice Address - Phone:701-221-2636
Practice Address - Fax:701-221-2637
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN711228Medicare ID - Type Unspecified
NDU74829Medicare UPIN