Provider Demographics
NPI:1194965079
Name:MILLER, JASON EVERETT (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:EVERETT
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 1:21 COLUMBUS AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-2100
Mailing Address - Country:US
Mailing Address - Phone:415-373-3897
Mailing Address - Fax:866-543-9129
Practice Address - Street 1:21 COLUMBUS AVE STE 206
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-2100
Practice Address - Country:US
Practice Address - Phone:415-373-3897
Practice Address - Fax:866-543-9129
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30948111NR0400X
CO6126111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation