Provider Demographics
NPI:1124030671
Name:MULLER, KENNETH GERARD (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:GERARD
Last Name:MULLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5408 DISCOVERY PARK BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2893
Mailing Address - Country:US
Mailing Address - Phone:757-220-8552
Mailing Address - Fax:757-220-0162
Practice Address - Street 1:5408 DISCOVERY PARK BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2893
Practice Address - Country:US
Practice Address - Phone:757-220-8552
Practice Address - Fax:757-220-0162
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA54-1875990OtherTAX ID