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General NPI Number Information
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NPI Number | 1518030584
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Entity Type | Organization
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Legal Business Name | QUALITY LIFE HEALTH CENTER INC P S
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 03/25/2016
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Provider Practice Location Address
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Address Line | 113 W MAIN ST.
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City | CRAIGMONT
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State | ID
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Zip | 83523-0311
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Country | US
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Telephone | 208-820-4148
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 311
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City | CRAIGMONT
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State | ID
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Zip | 83523-0311
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Country | US
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Telephone | 208-820-4148
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Fax |
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Authorized Official
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Title or Position | CORP. PRESIDENT - C.E.O.
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Name | DR. LOREN C MILLER
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Credential | DC
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Telephone | 208-820-4148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number |
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License Number State |
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