Provider Demographics
NPI:1164432688
Name:MILLER, KEVIN DWAYNE (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DWAYNE
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 1:1907 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-6646
Mailing Address - Country:US
Mailing Address - Phone:337-363-1554
Mailing Address - Fax:337-363-1554
Practice Address - Street 1:1907 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-6646
Practice Address - Country:US
Practice Address - Phone:337-363-1554
Practice Address - Fax:337-363-1554
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
3445FMedicare UPIN