Provider Demographics
NPI:1972591493
Name:MILLER, CASEY C (DC)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:C
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 1:605 ONTARIO ST
Mailing Address - Street 2:
Mailing Address - City:STORM LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50588-1844
Mailing Address - Country:US
Mailing Address - Phone:712-732-1952
Mailing Address - Fax:
Practice Address - Street 1:605 ONTARIO ST
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-1844
Practice Address - Country:US
Practice Address - Phone:712-732-1952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0192328Medicaid
IA49632Medicare ID - Type Unspecified