Provider Demographics
NPI:1033677893
Name:MILLER-HUGGINS, KIM C (LMT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:C
Last Name:MILLER-HUGGINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7428 WASHINGTON ST APT 208
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1500
Mailing Address - Country:US
Mailing Address - Phone:773-459-6645
Mailing Address - Fax:
Practice Address - Street 1:7451 MADISON ST
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-1596
Practice Address - Country:US
Practice Address - Phone:773-459-6645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2270202755225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist