Provider Demographics
NPI:1558602565
Name:MILLER CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:MILLER CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MADELAINE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-235-4956
Mailing Address - Street 1:735 ENGLISH DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1627
Mailing Address - Country:US
Mailing Address - Phone:307-235-4956
Mailing Address - Fax:
Practice Address - Street 1:735 ENGLISH DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1627
Practice Address - Country:US
Practice Address - Phone:307-235-4956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY461305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW302449Medicare UPIN