Provider Demographics
NPI:1427228170
Name:MILLER, CLOTHIELD S (DC)
Entity Type:Individual
Prefix:
First Name:CLOTHIELD
Middle Name:S
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 1:708 CHURCH ST
Mailing Address - Street 2:SUITE 228
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3875
Mailing Address - Country:US
Mailing Address - Phone:847-570-0970
Mailing Address - Fax:847-570-0972
Practice Address - Street 1:708 CHURCH ST
Practice Address - Street 2:SUITE 228
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3875
Practice Address - Country:US
Practice Address - Phone:847-570-0970
Practice Address - Fax:847-570-0972
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL547220Medicare UPIN