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General NPI Number Information
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NPI Number | 1588861215
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Entity Type | Organization
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Legal Business Name | LARRY MILLER CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 07/24/2007
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Provider Practice Location Address
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Address Line | 1636 COUNTY ROAD E E
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City | SAINT PAUL
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State | MN
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Zip | 55110-4637
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Country | US
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Telephone | 651-773-9560
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Fax | 651-773-9546
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Provider Business Mailing Address
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Address Line | 1636 COUNTY ROAD E E
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City | SAINT PAUL
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State | MN
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Zip | 55110-4637
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Country | US
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Telephone | 651-773-9560
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Fax | 651-773-9546
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAWRENCE GEORGE MILLER
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Credential | D.C.
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Telephone | 651-773-9560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2121
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License Number State | MN
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