Provider Demographics
NPI:1093011330
Name:MILLER CHIROPRACTIC LIFE CENTER, P.L.L.C.
Entity Type:Organization
Organization Name:MILLER CHIROPRACTIC LIFE CENTER, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-674-7300
Mailing Address - Street 1:5601 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1927
Mailing Address - Country:US
Mailing Address - Phone:248-674-7300
Mailing Address - Fax:248-674-8091
Practice Address - Street 1:5601 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1927
Practice Address - Country:US
Practice Address - Phone:248-674-7300
Practice Address - Fax:248-674-8091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F35143OtherBCBS OF MICHIGAN
MI0F35143Medicare PIN