Provider Demographics
NPI:1053600445
Name:WAYNE R. MILLER CHIROPRACTIC CORP.
Entity type:Organization
Organization Name:WAYNE R. MILLER CHIROPRACTIC CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-934-5703
Mailing Address - Street 1:2441 PROFESSIONAL PKWY
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-1684
Mailing Address - Country:US
Mailing Address - Phone:805-934-5703
Mailing Address - Fax:805-934-1590
Practice Address - Street 1:2441 PROFESSIONAL PKWY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1684
Practice Address - Country:US
Practice Address - Phone:805-934-5703
Practice Address - Fax:805-934-1590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16640111NN0400X
CA9471111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT18984Medicare UPIN
CADC9471Medicare PIN
CAT18380Medicare UPIN
CA350012339Medicare PIN
CADC16640Medicare PIN