MEDICARE: DR. LACEY MILLER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	2015001800	MO
2	111N00000X	Chiropractor	2015001800	MO

General Provider Information

NPI Number	:	1356711428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LACEY MILLER DC

Provider Business Mailing Address
First Line	:	605 N COMMERCIAL AVE
Second Line	:
City	:	SAINT CLAIR
State	:	MO
Zip	:	63077-1103
Country	:	US
Telephone Number	:	636-629-2414
Fax Number	:	636-629-2406

Provider Business Practice Location Address
First Line	:	605 N COMMERCIAL AVE
Second Line	:
City	:	SAINT CLAIR
State	:	MO
Zip	:	63077-1103
Country	:	US
Telephone Number	:	636-629-2414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2015
Last Update Date	:	03/17/2018

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Directions to “ DR. LACEY MILLER DC” Practice Location

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