Provider Demographics
NPI:1922008259
Name:MILLER, COLLEEN MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:COLLEEN
Other - Middle Name:MARIE
Other - Last Name:STRATTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:343 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-1338
Mailing Address - Country:US
Mailing Address - Phone:618-939-5585
Mailing Address - Fax:618-939-2099
Practice Address - Street 1:343 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-1338
Practice Address - Country:US
Practice Address - Phone:618-939-5585
Practice Address - Fax:618-939-2099
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL120511OtherHEALTHLINK
IL44-00540OtherUNITED HEALTHCARE
IL155541OtherBCBS OF MISSOURI
IL06725377OtherBCBS OF ILLINOIS
IL06725377OtherBCBS OF ILLINOIS
IL120511OtherHEALTHLINK