Provider Demographics
NPI:1801092168
Name:MILLER CHIROPRACTIC & LASER TREATMENT CENTER, LTD.
Entity type:Organization
Organization Name:MILLER CHIROPRACTIC & LASER TREATMENT CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-395-7246
Mailing Address - Street 1:124 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-2839
Mailing Address - Country:US
Mailing Address - Phone:618-395-7246
Mailing Address - Fax:618-395-7249
Practice Address - Street 1:124 S EAST ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2839
Practice Address - Country:US
Practice Address - Phone:618-395-7246
Practice Address - Fax:618-395-7249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042.618421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210796Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #