Provider Demographics
NPI:1720567803
Name:MILLER, TAYLOR VICTORIA (DC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:VICTORIA
Last Name:MILLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:VICTORIA
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:707 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:IA
Mailing Address - Zip Code:50003-1523
Mailing Address - Country:US
Mailing Address - Phone:515-478-3183
Mailing Address - Fax:
Practice Address - Street 1:707 MAIN ST
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:IA
Practice Address - Zip Code:50003-1523
Practice Address - Country:US
Practice Address - Phone:515-478-3183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003045A111N00000X
IA097524111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor