Provider Demographics
NPI:1730394271
Name:MILLER, JOEL SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:SCOTT
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 1:21857 RAINBOW LAKE CT
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-6297
Mailing Address - Country:US
Mailing Address - Phone:239-947-5783
Mailing Address - Fax:
Practice Address - Street 1:28340 TRAILS EDGE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7586
Practice Address - Country:US
Practice Address - Phone:239-992-7178
Practice Address - Fax:239-992-6134
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4477111N00000X
FLCH0004477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70554Medicare ID - Type Unspecified