Provider Demographics
NPI:1780763128
Name:MIRON, BRUCE R (DC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:R
Last Name:MIRON
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 1:10955 JONES BRIDGE RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8109
Mailing Address - Country:US
Mailing Address - Phone:770-410-1234
Mailing Address - Fax:770-410-9114
Practice Address - Street 1:10955 JONES BRIDGE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-8109
Practice Address - Country:US
Practice Address - Phone:770-410-1234
Practice Address - Fax:770-410-9114
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR004763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCCGZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NO