Provider Demographics
NPI:1013131176
Name:MILLER, KEVIN MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
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 1:1607 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4806
Mailing Address - Country:US
Mailing Address - Phone:432-550-8875
Mailing Address - Fax:432-550-8895
Practice Address - Street 1:1607 E 8TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4806
Practice Address - Country:US
Practice Address - Phone:432-550-8875
Practice Address - Fax:432-550-8895
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6461111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX002036401Medicaid
VI00775YMedicare ID - Type Unspecified
TX002036401Medicaid