1295808343 NPI number — DR. LOREN C MILLER DC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295808343 NPI number — DR. LOREN C MILLER DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
LOREN
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295808343
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANGEVILLE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83530-1448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-820-4148
Provider Business Mailing Address Fax Number:
844-213-5856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANGEVILLE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83530-1448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-820-4148
Provider Business Practice Location Address Fax Number:
844-213-5856
Provider Enumeration Date:
11/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NX0800X , with the licence number:  CH00002907 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NX0800X , with the licence number: CHIA - 742 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GAB38035 . This is a "MEDICARE PTAN GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: GAB38939 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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