Provider Demographics
NPI:1144208042
Name:MILLER, KEVIN DENNIS (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DENNIS
Last Name:MILLER
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 1:1905 EP TRUE PKWY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-7056
Mailing Address - Country:US
Mailing Address - Phone:515-309-3791
Mailing Address - Fax:515-309-3792
Practice Address - Street 1:1905 EP TRUE PKWY
Practice Address - Street 2:#207
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-7000
Practice Address - Country:US
Practice Address - Phone:515-309-3791
Practice Address - Fax:515-309-3792
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3220715Medicaid
IAI6197Medicare ID - Type Unspecified