Provider Demographics
NPI:1245503861
Name:KENNETH V MILLER D.C P.C
Entity type:Organization
Organization Name:KENNETH V MILLER D.C P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:OLHEISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-296-3290
Mailing Address - Street 1:600 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-2234
Mailing Address - Country:US
Mailing Address - Phone:541-296-3290
Mailing Address - Fax:541-296-3251
Practice Address - Street 1:600 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-2234
Practice Address - Country:US
Practice Address - Phone:541-296-3290
Practice Address - Fax:541-296-3251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty