Provider Demographics
NPI:1639375629
Name:MILLER, KENNETH J (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
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:PO BOX 1463
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24068-1463
Mailing Address - Country:US
Mailing Address - Phone:540-951-6900
Mailing Address - Fax:540-951-8900
Practice Address - Street 1:2445 E WASHINGTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:VINTON
Practice Address - State:VA
Practice Address - Zip Code:24179-1589
Practice Address - Country:US
Practice Address - Phone:540-890-1444
Practice Address - Fax:540-890-1131
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007015101111N00000X
VA0104555572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2007015101OtherMO - LICENSE
KYT69333Medicare UPIN
MO2007015101OtherMO - LICENSE