Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038-005673 | IL |
NPI | 1003920265 |
---|---|
Provider Name | Terrence Miller |
First Address | Grayslake, IL 60030-1535 |
Second Address | Grayslake, IL 60030-1535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T38660 | (02) |