Provider Demographics
NPI:1194077511
Name:MILLER CHIROPRACTIC CENTER, INC.
Entity type:Organization
Organization Name:MILLER CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-386-2515
Mailing Address - Street 1:206 N GRIMMELL RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:IA
Mailing Address - Zip Code:50129-1732
Mailing Address - Country:US
Mailing Address - Phone:515-386-2515
Mailing Address - Fax:515-386-4286
Practice Address - Street 1:206 N GRIMMELL RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:IA
Practice Address - Zip Code:50129-1732
Practice Address - Country:US
Practice Address - Phone:515-386-2515
Practice Address - Fax:515-386-4286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO5386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1123117Medicaid
350046121OtherRR MD
IA57983OtherBLUE CROSS/ BLUE SHIELD
350046121OtherRR MD