Provider Demographics
NPI:1396733804
Name:MILLER, JAMES WIRICK JR (ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WIRICK
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 1/2 W LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47601-1520
Mailing Address - Country:US
Mailing Address - Phone:812-897-2203
Mailing Address - Fax:812-897-6061
Practice Address - Street 1:300 N 1ST ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-1516
Practice Address - Country:US
Practice Address - Phone:812-897-4701
Practice Address - Fax:812-897-6061
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000455A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist