Provider Demographics
NPI:1982685517
Name:MILLER, NICOLE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARIE
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 1:508 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ESTHERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51334-1834
Mailing Address - Country:US
Mailing Address - Phone:712-362-7715
Mailing Address - Fax:712-362-7716
Practice Address - Street 1:508 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ESTHERVILLE
Practice Address - State:IA
Practice Address - Zip Code:51334-1834
Practice Address - Country:US
Practice Address - Phone:712-362-7715
Practice Address - Fax:712-362-7716
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1190777Medicaid
IAI10219Medicare ID - Type UnspecifiedMEDICARE NUMBER
IAU75040Medicare UPIN