Provider Demographics
NPI:1922177765
Name:MILLER, BRIAN JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOSEPH
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 1:1354 W TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4754
Mailing Address - Country:US
Mailing Address - Phone:312-733-8589
Mailing Address - Fax:312-733-8533
Practice Address - Street 1:1354 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4754
Practice Address - Country:US
Practice Address - Phone:312-733-8589
Practice Address - Fax:312-733-8533
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009492111N00000X, 111NX0800X, 111NR0400X, 111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01630306OtherBCBS
IL01630306OtherBCBS