Provider Demographics
NPI:1346325826
Name:MILLER, MELVIN GERARD (DC)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:GERARD
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 1:1183 EAST MAIN STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-7165
Mailing Address - Country:US
Mailing Address - Phone:619-579-8585
Mailing Address - Fax:619-593-1685
Practice Address - Street 1:1183 EAST MAIN STREET
Practice Address - Street 2:SUITE C
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-7165
Practice Address - Country:US
Practice Address - Phone:619-579-8585
Practice Address - Fax:619-593-1685
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0185410Medicaid
CADC0185410Medicaid