DR. CLINT D. MILLER D.C., NPI 1467403824 — JACKSONVILLE (FL)

NPI 1467403824

13+ Years Experience Individual

DR. CLINT D. MILLER D.C.

05.12.2006
PROVIDER ENUMERATION DATE
03/20/2013
LAST UPDATE DATE
1467403824
NPI NUMBER

About DR. CLINT D. MILLER

Sole proprietor? No, Entity Type 1 Provider (Individual) is not a Sole Proprietor.

DR. CLINT D. MILLER is a provider established in JACKSONVILLE, FL. The NPI number of DR. CLINT D. MILLER is 1467403824 and was assigned on 05.12.2006. The practitioners primary taxonomy code is: 111NS0005X with license number: CH6086 FL .

Mailing address

  • City: JACKSONVILLE
  • State: FL
  • Postal code: 322466615
  • Phone: 9046423304
  • Fax: 9049283561
  • Address: 11761 BEACH BLVD
  • Address 2: SUITE 8

Primary Practice Address

  • Region : JACKSONVILLE, FL
  • NPI : 1467403824
  • Phone : 9046423304
  • Fax : 9049283561
  • Postalcode : 322466615
  • Address : 11761 BEACH BLVD SUITE 8

Additional identifiers

  • Identifier: 51010600
  • Code / Type : 5 - MEDICAID
  • Identifier state : FL

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Provider taxonomy - Chiropractor

  • Taxonomy code: 111NS0005X
  • License number: CH6086
  • License state: FL

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: A sports chiropractor is uniquely trained to provide care and treatment of injuries or illness resulting from sports and physical fitness activities. Doctors of Chiropractic with the Diplomate American Chiropractic Board of Sports Physicians (DACBSP) or the Certified Chiropractic Sports Physician (CCSP), sport specialty certifications from the American Chiropractic Board of Sports Physicians, have advanced training in the assessment, management and rehabilitation of sports related injuries. Extremity care, rehabilitation and soft tissue procedures are common skills utilized by these doctors. The specialty training covers a broad spectrum from the pediatric athlete to professional and Olympic athletes, and everything in between, using a variety of techniques and modalities.

Contacts:

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  • DR. CLINT D. MILLER D.C.
  • Address : 11761 BEACH BLVD SUITE 8
  • Region : JACKSONVILLE, FL
  • NPI : 1467403824
  • Phone : 9046423304
  • Fax : 9049283561
  • Postalcode : 322466615

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address11761 BEACH BLVD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location AddressSUITE 8
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameJACKSONVILLE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameFL
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code322466615
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number9046423304
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number9049283561
The fax number associated with the location address of the provider being identified.
NPI1467403824
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1111NS0005X
A sports chiropractor is uniquely trained to provide care and treatment of injuries or illness resulting from sports and physical fitness activities. Doctors of Chiropractic with the Diplomate American Chiropractic Board of Sports Physicians (DACBSP) or the Certified Chiropractic Sports Physician (CCSP), sport specialty certifications from the American Chiropractic Board of Sports Physicians, have advanced training in the assessment, management and rehabilitation of sports related injuries. Extremity care, rehabilitation and soft tissue procedures are common skills utilized by these doctors. The specialty training covers a broad spectrum from the pediatric athlete to professional and Olympic athletes, and everything in between, using a variety of techniques and modalities.
Provider Enumeration Date05.12.2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated03/20/2013
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)DR. CLINT D. MILLER
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address11761 BEACH BLVD
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing AddressSUITE 8
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NameJACKSONVILLE
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameFL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code322466615
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number9046423304
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number9049283561
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #1111NS0005X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Chiropractor
A sports chiropractor is uniquely trained to provide care and treatment of injuries or illness resulting from sports and physical fitness activities. Doctors of Chiropractic with the Diplomate American Chiropractic Board of Sports Physicians (DACBSP) or the Certified Chiropractic Sports Physician (CCSP), sport specialty certifications from the American Chiropractic Board of Sports Physicians, have advanced training in the assessment, management and rehabilitation of sports related injuries. Extremity care, rehabilitation and soft tissue procedures are common skills utilized by these doctors. The specialty training covers a broad spectrum from the pediatric athlete to professional and Olympic athletes, and everything in between, using a variety of techniques and modalities.
Provider License Number 1CH6086
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1FL
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 151010600
Other Provider Identifier #1
Other Provider Identifier Type 15
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1FL
Other Provider Identifier State #1
Provider Gender CodeM
  • M - male
  • F - female
Is sole proprietorN
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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