Provider Demographics
NPI:1427860832
Name:MILLER, JACKLYN (DAC)
Entity type:Individual
Prefix:DR
First Name:JACKLYN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:DAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-2209
Mailing Address - Country:US
Mailing Address - Phone:201-835-7461
Mailing Address - Fax:
Practice Address - Street 1:1920 DOG KENNEL RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1008
Practice Address - Country:US
Practice Address - Phone:484-222-0452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001475171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist