Provider Demographics
NPI:1487730578
Name:MILLER, RYAN J (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:J
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 1:1006 5TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2901
Mailing Address - Country:US
Mailing Address - Phone:319-338-3801
Mailing Address - Fax:319-338-4003
Practice Address - Street 1:1006 5TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2901
Practice Address - Country:US
Practice Address - Phone:319-338-3801
Practice Address - Fax:319-338-4003
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO5740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA14928OtherWELLMARK
IA0132068Medicaid
IA0132068Medicaid