Provider Demographics
NPI:1124056940
Name:MILLER, JIMMIE B JR (DC)
Entity type:Individual
Prefix:DR
First Name:JIMMIE
Middle Name:B
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8330 BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1113
Mailing Address - Country:US
Mailing Address - Phone:925-634-2497
Mailing Address - Fax:925-634-2492
Practice Address - Street 1:8330 BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1113
Practice Address - Country:US
Practice Address - Phone:925-634-2497
Practice Address - Fax:925-634-2492
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0245110Medicare ID - Type Unspecified