MEDICARE: DR. FRANK DEREK MILLER D.C.

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	111N00000X	Chiropractor		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01636210	OTHER	IL	BCBS ILLINOIS PROVIDER #

General Provider Information

NPI Number	:	1861546962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANK DEREK MILLER D.C.

Provider Business Mailing Address
First Line	:	6208 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-1208
Country	:	US
Telephone Number	:	773-338-5563
Fax Number	:	773-338-5548

Provider Business Practice Location Address
First Line	:	6208 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-1208
Country	:	US
Telephone Number	:	773-338-5563
Fax Number	:	773-338-5548

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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