Provider Demographics
NPI:1679524953
Name:MILLER, THOMAS DARRELL (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DARRELL
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 1:1502 N PINE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-3543
Mailing Address - Country:US
Mailing Address - Phone:541-963-7432
Mailing Address - Fax:541-963-0597
Practice Address - Street 1:1502 N PINE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-3543
Practice Address - Country:US
Practice Address - Phone:541-963-7432
Practice Address - Fax:541-963-0597
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR713618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134740Medicare PIN
ORV09400Medicare UPIN