Provider Demographics
NPI:1598877722
Name:ANDERSEN, KAY MILLER (DC)
Entity Type:Individual
Prefix:DR
First Name:KAY
Middle Name:MILLER
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CAROLYN KAY
Other - Middle Name:MILLER
Other - Last Name:ANDERSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:983 MISSION DE ORO DR #A
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-3850
Mailing Address - Country:US
Mailing Address - Phone:530-222-5920
Mailing Address - Fax:
Practice Address - Street 1:983 MISSION DE ORO DR STE A
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-3850
Practice Address - Country:US
Practice Address - Phone:530-222-5920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0224110111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU40218Medicare UPIN