Provider Demographics
NPI:1912033135
Name:MILLER, HEATHER ELAINE (DC)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ELAINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2138 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-5004
Mailing Address - Country:US
Mailing Address - Phone:574-533-0377
Mailing Address - Fax:574-534-4356
Practice Address - Street 1:2138 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528-5004
Practice Address - Country:US
Practice Address - Phone:574-533-0377
Practice Address - Fax:574-534-4356
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001719A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN352020775OtherTIN