Provider Demographics
NPI:1518063460
Name:MILLER, KAY A (DOCTOR OF CHIROPRACT)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:DOCTOR OF CHIROPRACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4951
Mailing Address - Country:US
Mailing Address - Phone:920-933-3536
Mailing Address - Fax:920-933-3538
Practice Address - Street 1:435 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4951
Practice Address - Country:US
Practice Address - Phone:920-933-3536
Practice Address - Fax:920-933-3538
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI3611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U65962Medicare UPIN
000035487Medicare ID - Type Unspecified