=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427069335
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VIRGIL HENRY MILLER III D.C.,LAC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2006
-----------------------------------------------------
Last Update Date | 08/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1225 W LAKEVIEW CT
-----------------------------------------------------
City | ROMEOVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60446-6501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-226-5660
-----------------------------------------------------
Fax | 630-226-6998
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1503 FIRETHORN ST
-----------------------------------------------------
City | BOLINGBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60490-2001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-378-0189
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038-008954
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------