Provider Demographics
NPI:1003840711
Name:MILLER, KIM C (DC, ATC)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:C
Last Name:MILLER
Suffix:
Gender:M
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 FRONT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1562
Mailing Address - Country:US
Mailing Address - Phone:607-786-3601
Mailing Address - Fax:607-834-7029
Practice Address - Street 1:130 FRONT ST
Practice Address - Street 2:SUITE B
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1562
Practice Address - Country:US
Practice Address - Phone:607-786-3601
Practice Address - Fax:607-834-7029
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX00996-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000143666OtherBC/BS
NY100651380167OtherCDPHP
NY000143666OtherBC/BS