Provider Demographics
NPI:1538118633
Name:MILLER, GUY BRADFORD (DC)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:BRADFORD
Last Name:MILLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 S COURT ST
Mailing Address - Street 2:P.O. BOX 1008
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-2712
Mailing Address - Country:US
Mailing Address - Phone:618-997-8066
Mailing Address - Fax:618-997-7702
Practice Address - Street 1:404 S COURT ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-2712
Practice Address - Country:US
Practice Address - Phone:618-997-8066
Practice Address - Fax:618-997-7702
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10022981OtherBLUE CROSS/BLUE SHIELD ID
401543OtherHEALTHLINK PIN
401543OtherHEALTHLINK PIN
U73084Medicare UPIN