Provider Demographics
NPI:1912611609
Name:MILLER, LEVI J (DC)
Entity Type:Individual
Prefix:
First Name:LEVI
Middle Name:J
Last Name:MILLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13944 REFLECTION DR APT 117
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-8053
Mailing Address - Country:US
Mailing Address - Phone:636-358-0547
Mailing Address - Fax:
Practice Address - Street 1:17684 CHESTERFIELD AIRPORT RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1214
Practice Address - Country:US
Practice Address - Phone:636-345-4816
Practice Address - Fax:636-736-0292
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022049919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor