Provider Demographics
NPI:1104962877
Name:MILLER, GREGORY JON (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JON
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 1:7000 VILLAGE PKWY
Mailing Address - Street 2:SUITE H
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2413
Mailing Address - Country:US
Mailing Address - Phone:925-829-5040
Mailing Address - Fax:925-829-5041
Practice Address - Street 1:7000 VILLAGE PKWY
Practice Address - Street 2:SUITE H
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2413
Practice Address - Country:US
Practice Address - Phone:925-829-5040
Practice Address - Fax:925-829-5041
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor