Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 08003059A | IN |
Y | 111N00000X | Chiropractor | 097525 | IA |
NPI | 1003382326 |
---|---|
Provider Name | Bryce Andrew Miller |
First Address | Adel, IA 50003-1523 |
Second Address | Adel, IA 50003-1523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2018 |
Last Update Date | 07/08/2019 |