Provider Demographics
NPI:1679609531
Name:MILLER, BRAD T (DC)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:T
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 1:2183 FAIRVIEW RD.
Mailing Address - Street 2:STE. 105
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627
Mailing Address - Country:US
Mailing Address - Phone:949-650-8970
Mailing Address - Fax:
Practice Address - Street 1:1072 BRISTOL ST
Practice Address - Street 2:STE. 101
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-8652
Practice Address - Country:US
Practice Address - Phone:949-650-8970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21061111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor