Provider Demographics
NPI:1346630878
Name:MILLER, LA JENA (DC)
Entity Type:Individual
Prefix:
First Name:LA JENA
Middle Name:
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 1:5800 W ADAMS ST
Mailing Address - Street 2:2E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-4660
Mailing Address - Country:US
Mailing Address - Phone:312-757-9137
Mailing Address - Fax:
Practice Address - Street 1:3444 N HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-9492
Practice Address - Country:US
Practice Address - Phone:773-525-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor