Provider Demographics
NPI:1912182742
Name:MILLER, LYNN M (DC)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:M
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 1:4739 COUNTY ROAD 101
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-2634
Mailing Address - Country:US
Mailing Address - Phone:952-933-2695
Mailing Address - Fax:952-933-2763
Practice Address - Street 1:14525 HWY 7, SUITE 115,
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345
Practice Address - Country:US
Practice Address - Phone:952-746-5612
Practice Address - Fax:952-229-4153
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN325J4MIOtherBLUE CROSS BLUE SHEILD
MN350001701OtherMEDICARE PROVIDER