Provider Demographics
NPI:1366769770
Name:MILLER, LORI LEE (DC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 W BELL RD
Mailing Address - Street 2:BUILDING H SUITE 103
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8529
Mailing Address - Country:US
Mailing Address - Phone:623-780-2688
Mailing Address - Fax:623-878-4585
Practice Address - Street 1:7200 W BELL RD
Practice Address - Street 2:BUILDING H SUITE 103
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8529
Practice Address - Country:US
Practice Address - Phone:623-780-2688
Practice Address - Fax:623-878-4585
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-24
Last Update Date:2010-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4284111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP0233230OtherP NUMBER