Provider Demographics
NPI:1053621011
Name:MILLER, SEAN MATTHEW (DC)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:MATTHEW
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 1:56 EDWARDS VILLAGE BLVD
Mailing Address - Street 2:UNIT 114
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-7802
Mailing Address - Country:US
Mailing Address - Phone:970-766-7100
Mailing Address - Fax:
Practice Address - Street 1:56 EDWARDS VILLAGE BLVD
Practice Address - Street 2:UNIT 114
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-7802
Practice Address - Country:US
Practice Address - Phone:970-766-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6578111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor