Provider Demographics
NPI:1659497790
Name:MILLER, WAIDE LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:WAIDE
Middle Name:LEE
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 1:61 S OLD RAND RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-3127
Mailing Address - Country:US
Mailing Address - Phone:847-540-1439
Mailing Address - Fax:847-540-6407
Practice Address - Street 1:61 S OLD RAND RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-3127
Practice Address - Country:US
Practice Address - Phone:847-540-1439
Practice Address - Fax:847-540-6407
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X, 111NN0400X, 111NR0400X, 111NS0005X, 111NT0100X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NN0400XChiropractic ProvidersChiropractorNeurology
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Not Answered111NT0100XChiropractic ProvidersChiropractorThermography
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID04932265OtherBLUE CROSS BLUE SHIELD ID
IL209789Medicare ID - Type Unspecified