Provider Demographics
NPI:1356411961
Name:MILLER, PAUL JERRY (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JERRY
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 1:227 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:DEVON
Mailing Address - State:PA
Mailing Address - Zip Code:19333-1805
Mailing Address - Country:US
Mailing Address - Phone:610-688-1911
Mailing Address - Fax:610-964-6144
Practice Address - Street 1:227 CHURCH RD
Practice Address - Street 2:
Practice Address - City:DEVON
Practice Address - State:PA
Practice Address - Zip Code:19333-1805
Practice Address - Country:US
Practice Address - Phone:610-688-1911
Practice Address - Fax:610-964-6144
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002755L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor