Provider Demographics
NPI:1619013794
Name:MILLER, ANGELA LYNNE (DC)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:LYNNE
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 1:220 W MAIN ST
Mailing Address - Street 2:P.O. BOX 115
Mailing Address - City:PIPESTONE
Mailing Address - State:MN
Mailing Address - Zip Code:56164-1634
Mailing Address - Country:US
Mailing Address - Phone:507-825-4225
Mailing Address - Fax:507-562-4225
Practice Address - Street 1:220 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PIPESTONE
Practice Address - State:MN
Practice Address - Zip Code:56164-1634
Practice Address - Country:US
Practice Address - Phone:507-825-4225
Practice Address - Fax:507-562-4225
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4119111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU86809Medicare UPIN