Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2015001800 | MO |
N | 111NS0005X | Chiropractic Sports Physician | 2015001800 | MO |
NPI | 1356711428 |
---|---|
Provider Name | Dr. Lacey Miller |
First Address | Saint Clair, MO 63077-1103 |
Second Address | Saint Clair, MO 63077-1103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2015 |
Last Update Date | 17/03/2018 |