Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038008356 | IL |
NPI | 1003880394 |
---|---|
Provider Name | Dr. Daniel Jon Miller |
First Address | Ottawa, IL 61350-2563 |
Second Address | Ottawa, IL 61350 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 10/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
038008356 | (05) | IL |
5072029 | BCBS (01) | IL |
K02773 | (02) | IL |