Provider Demographics
NPI:1215023379
Name:MILLER, ELIZABETH LAURA (DC)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LAURA
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 1:403 MACY DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-6353
Mailing Address - Country:US
Mailing Address - Phone:770-993-5009
Mailing Address - Fax:770-993-5118
Practice Address - Street 1:403 MACY DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-6353
Practice Address - Country:US
Practice Address - Phone:770-993-5009
Practice Address - Fax:770-993-5118
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
35ZCJMTMedicare ID - Type Unspecified
VO8366Medicare UPIN