Provider Demographics
NPI:1699521393
Name:MILLER, CHRISTOPHER ROY (PEER SPECIALIST - 1)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ROY
Last Name:MILLER
Suffix:
Gender:M
Credentials:PEER SPECIALIST - 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4788 SKYLINE RD S APT 15
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-2060
Mailing Address - Country:US
Mailing Address - Phone:971-304-1752
Mailing Address - Fax:
Practice Address - Street 1:211 BOONE RD SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-1954
Practice Address - Country:US
Practice Address - Phone:971-304-1752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist