Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | IL | |
N | 111NN0400X | Neurology | IL | |
N | 111NR0400X | Rehabilitation Chiropractor | IL | |
N | 111NS0005X | Chiropractic Sports Physician | IL | |
N | 111NT0100X | Thermography | IL | |
N | 111NX0800X | Chiropractor Orthopedic Specialist | IL |
NPI | 1659497790 |
---|---|
Provider Name | Dr. Waide Lee Miller |
First Address | Lake Zurich, IL 60047-3127 |
Second Address | Lake Zurich, IL 60047-3127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04932265 | BLUE CROSS BLUE SHIELD ID (01) | ID |