Provider Demographics
NPI:1053521591
Name:MILLER, GARY THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:THOMAS
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 1:2627 E FRANKLIN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1103
Mailing Address - Country:US
Mailing Address - Phone:612-870-1500
Mailing Address - Fax:612-870-1551
Practice Address - Street 1:2627 E FRANKLIN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1103
Practice Address - Country:US
Practice Address - Phone:612-870-1500
Practice Address - Fax:612-870-1551
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1326111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor