Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038011338 | IL |
NPI | 1003043092 |
---|---|
Provider Name | Dr. Nathan Glen Miller |
First Address | Roselle, IL 60172-3572 |
Second Address | Roselle, IL 60172-3572 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2009 |
Last Update Date | 10/05/2010 |