Provider Demographics
NPI:1124074646
Name:MYLER, VICTORIA
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:MYLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 S WASHINGTON ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-6370
Mailing Address - Country:US
Mailing Address - Phone:630-357-8441
Mailing Address - Fax:630-357-1510
Practice Address - Street 1:2603 S WASHINGTON ST
Practice Address - Street 2:SUITE 140
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-6370
Practice Address - Country:US
Practice Address - Phone:630-357-8441
Practice Address - Fax:630-357-1510
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL521990Medicare ID - Type Unspecified