Provider Demographics
NPI:1154469377
Name:MILLER, MARK ALAN (DC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALAN
Last Name:MILLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 CORPORATE DR STE 302
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-5410
Mailing Address - Country:US
Mailing Address - Phone:330-302-4136
Mailing Address - Fax:330-302-4083
Practice Address - Street 1:811 CORPORATE DR STE 302
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-5410
Practice Address - Country:US
Practice Address - Phone:330-302-4136
Practice Address - Fax:330-302-4083
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC138410Medicare ID - Type Unspecified