# MILLER SPORTS & WELLNESS CHIROPRACTIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528351806
- **Authorized official:** DR. THERESE MILLER D.C. (OWNER)
- **Authorized official phone:** (262) 366-3655

## Contact information

- **Practice address:** 2363 S 102ND ST, SUITE 304, WEST ALLIS, WI 53227-2143
- **Practice address phone:** (262) 366-3655
- **Practice address fax:** (262) 565-4304
- **Mailing address:** 2363 S 102ND ST, SUITE 304, WEST ALLIS, WI 53227-2143
- **Mailing address phone:** (262) 366-3655
- **Mailing address fax:** (262) 565-4304

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 4664-012 | WI | Yes |

## Other

- **Enumeration date:** 05/19/2011
- **Last updated:** 05/19/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1497055644 | TYPE I NPI | WI |
| 05 | — | 71405 | — | WI |