Provider Demographics
NPI:1427069335
Name:MILLER, VIRGIL HENRY III (DC,LAC)
Entity type:Individual
Prefix:DR
First Name:VIRGIL
Middle Name:HENRY
Last Name:MILLER
Suffix:III
Gender:M
Credentials:DC,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 FIRETHORN ST
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-2001
Mailing Address - Country:US
Mailing Address - Phone:630-378-0189
Mailing Address - Fax:
Practice Address - Street 1:1225 W LAKEVIEW CT
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-6501
Practice Address - Country:US
Practice Address - Phone:630-226-5660
Practice Address - Fax:630-226-6998
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008954111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00132925OtherRAIL ROAD MEDICARE
IL02232061OtherBCBS
IL209008Medicare ID - Type Unspecified
ILU91064Medicare UPIN