Provider Demographics
NPI:1962430116
Name:MILLER, PAUL JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOHN
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 1:1004 SOUTH AVE W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7909
Mailing Address - Country:US
Mailing Address - Phone:406-721-4588
Mailing Address - Fax:406-721-1078
Practice Address - Street 1:1004 SOUTH AVE W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7909
Practice Address - Country:US
Practice Address - Phone:406-721-4588
Practice Address - Fax:406-721-1078
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor