Provider Demographics
NPI:1609174762
Name:MILLER CHIROPRACTIC LIFE CENTER PC
Entity Type:Organization
Organization Name:MILLER CHIROPRACTIC LIFE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:DANA
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-348-3500
Mailing Address - Street 1:41074 7 MILE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-2669
Mailing Address - Country:US
Mailing Address - Phone:248-348-3500
Mailing Address - Fax:248-348-1066
Practice Address - Street 1:41074 7 MILE RD
Practice Address - Street 2:SUITE A
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2669
Practice Address - Country:US
Practice Address - Phone:248-348-3500
Practice Address - Fax:248-348-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004002261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0Q25009OtherBLUE CROSS BLUE SHIELD MICHIGAN
MI0Q25009Medicare UPIN