Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NX0800X | Chiropractor Orthopedic Specialist | CH00002907 | WA |
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CHIA - 742 | ID |
NPI | 1295808343 |
---|---|
Provider Name | Dr. Loren C Miller |
First Address | Grangeville, ID 83530-1448 |
Second Address | Grangeville, ID 83530-1448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 04/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GAB38035 | MEDICARE PTAN GROUP (01) | |
GAB38939 | MEDICARE PTAN (01) | |
U44809 | (02) | WA |