Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | IL |
NPI | 1316044084 |
---|---|
Provider Name | Dr. Michael Donald Piller |
First Address | Peru, IL 61354-1385 |
Second Address | Peru, IL 61354-1385 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U93282 | (02) | IL |