Provider Demographics
NPI:1922534734
Name:MILLER, ANGELIQUE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELIQUE
Middle Name:
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 1:108 REPUBLIC AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6843
Mailing Address - Country:US
Mailing Address - Phone:337-456-6555
Mailing Address - Fax:337-706-7221
Practice Address - Street 1:108 REPUBLIC AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6843
Practice Address - Country:US
Practice Address - Phone:337-456-6555
Practice Address - Fax:337-706-7221
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor