Provider Demographics
NPI:1295808343
Name:MILLER, LOREN C (DC)
Entity type:Individual
Prefix:DR
First Name:LOREN
Middle Name:C
Last Name:MILLER
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRANGEVILLE
Mailing Address - State:ID
Mailing Address - Zip Code:83530-1448
Mailing Address - Country:US
Mailing Address - Phone:208-820-4148
Mailing Address - Fax:844-213-5856
Practice Address - Street 1:505 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GRANGEVILLE
Practice Address - State:ID
Practice Address - Zip Code:83530-1448
Practice Address - Country:US
Practice Address - Phone:208-820-4148
Practice Address - Fax:844-213-5856
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002907111NX0800X
IDCHIA - 742111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAB38035OtherMEDICARE PTAN GROUP
GAB38939OtherMEDICARE PTAN
WAU44809Medicare UPIN