Provider Demographics
NPI:1134182272
Name:MIESMER, JULIE ANNE (DC)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANNE
Last Name:MIESMER
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 1:300 W ADAMS ST
Mailing Address - Street 2:515
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-5101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 W ADAMS ST
Practice Address - Street 2:515
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-5101
Practice Address - Country:US
Practice Address - Phone:312-223-0692
Practice Address - Fax:312-223-0695
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
01634591OtherBLUECROSS BLUESHIELD
629115OtherACN PROVIDER
11181151OtherCAQH NUMBER
2139354OtherFIRST HEALTH NUMBER
46441OtherHFN NUMBER
V01136Medicare UPIN
11181151OtherCAQH NUMBER