Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 02 | NE |
NPI | 1003427055 |
---|---|
Provider Name | Dr. Andrew Jacob Gerald Marie Miller |
First Address | Grand Island, NE 68803-1240 |
Second Address | Grand Island, NE 68803-1240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2020 |
Last Update Date | 17/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (05) | NE |