Provider Demographics
NPI:1235401332
Name:MILLER, ERIN MARIE (DC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 COLLEGE AVE
Mailing Address - Street 2:SUITE M
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-1150
Mailing Address - Country:US
Mailing Address - Phone:414-762-0755
Mailing Address - Fax:414-762-0755
Practice Address - Street 1:1333 COLLEGE AVE
Practice Address - Street 2:SUITE M
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-1150
Practice Address - Country:US
Practice Address - Phone:414-762-0755
Practice Address - Fax:414-762-0755
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4938-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100026012Medicaid
WIK400162437Medicare PIN