Provider Demographics
NPI:1255465191
Name:MILLER, KRISTOPHER CARTER (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:CARTER
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 1:6480 WAYZATA BLVD BLDG GOLDEN
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1710
Mailing Address - Country:US
Mailing Address - Phone:763-593-0919
Mailing Address - Fax:763-593-9556
Practice Address - Street 1:6480 WAYZATA BLVD BLDG GOLDEN
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1710
Practice Address - Country:US
Practice Address - Phone:763-593-0919
Practice Address - Fax:763-593-9556
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3346111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor