Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 038012138 | IL |
NPI | 1215290598 |
---|---|
Provider Name | Casey Jade Miller |
First Address | San Antonio, TX 78232-5052 |
Second Address | La Grange, IL 60525-2499 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2012 |
Last Update Date | 17/09/2013 |