Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038009492 | IL |
N | 111NN0400X | Neurology | 038009492 | IL |
N | 111NR0400X | Rehabilitation Chiropractor | 038009492 | IL |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 038009492 | IL |
NPI | 1922177765 |
---|---|
Provider Name | Dr. Brian Joseph Miller |
First Address | Chicago, IL 60607-4754 |
Second Address | Chicago, IL 60607-4754 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 03/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01630306 | BCBS (01) | IL |
U87416 | (02) | IL |