Provider Demographics
NPI:1689965766
Name:BEARD, KIMBERLY KAREEN MILLER (DC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:KAREEN MILLER
Last Name:BEARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:KAREEN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:13105 SCHAVEY RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-9008
Mailing Address - Country:US
Mailing Address - Phone:517-668-6215
Mailing Address - Fax:517-668-6385
Practice Address - Street 1:13105 SCHAVEY RD
Practice Address - Street 2:SUITE 6
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-9008
Practice Address - Country:US
Practice Address - Phone:517-668-6215
Practice Address - Fax:517-668-6385
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2033274111N00000X
MI2301009772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI5917Medicare PIN