Provider Demographics
NPI:1245531896
Name:MILKE, KELLI BROOKE (LAC, MSOM)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:BROOKE
Last Name:MILKE
Suffix:
Gender:F
Credentials:LAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3527 W 12TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2564
Mailing Address - Country:US
Mailing Address - Phone:970-372-5847
Mailing Address - Fax:
Practice Address - Street 1:3527 W 12TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2564
Practice Address - Country:US
Practice Address - Phone:970-372-5847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-14
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1594171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist