Provider Demographics
NPI:1497055644
Name:MILLER, THERESE E (DC)
Entity Type:Individual
Prefix:DR
First Name:THERESE
Middle Name:E
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 1:2363 S 102ND ST
Mailing Address - Street 2:304
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2143
Mailing Address - Country:US
Mailing Address - Phone:262-366-3655
Mailing Address - Fax:
Practice Address - Street 1:2363 S 102ND ST
Practice Address - Street 2:304
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2143
Practice Address - Country:US
Practice Address - Phone:262-366-3655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4664-012111N00000X
IL038.011760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor