Provider Demographics
NPI:1811199961
Name:KMIEC, MICHELLE (DC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:KMIEC
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 PINE ST
Mailing Address - Street 2:G01
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4726
Mailing Address - Country:US
Mailing Address - Phone:802-863-5828
Mailing Address - Fax:802-863-9619
Practice Address - Street 1:431 PINE ST
Practice Address - Street 2:G01
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4726
Practice Address - Country:US
Practice Address - Phone:802-863-5828
Practice Address - Fax:802-863-9619
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor