MEDICARE: DR. JOHN A 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	111N00000X	Chiropractor	038009852	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09832017	OTHER	IL	BCBS
2	111541	OTHER		HEALTH PARTNERS

General Provider Information

NPI Number	:	1710953187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN A MILLER DC

Provider Business Mailing Address
First Line	:	406 N MADISON ST
Second Line	:
City	:	MORRISON
State	:	IL
Zip	:	61270-2834
Country	:	US
Telephone Number	:	815-772-7114
Fax Number	:

Provider Business Practice Location Address
First Line	:	406 N MADISON ST
Second Line	:
City	:	MORRISON
State	:	IL
Zip	:	61270-2834
Country	:	US
Telephone Number	:	815-772-7114
Fax Number	:

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	06/24/2008

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