Provider Demographics
NPI:1356436141
Name:MILLER, KEVIN ROY (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ROY
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 1:9285 TEDDY LANE
Mailing Address - Street 2:SUITE 145
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6706
Mailing Address - Country:US
Mailing Address - Phone:303-221-3342
Mailing Address - Fax:720-274-0718
Practice Address - Street 1:9285 TEDDY LANE
Practice Address - Street 2:SUITE 145
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6706
Practice Address - Country:US
Practice Address - Phone:303-221-3342
Practice Address - Fax:720-274-0718
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4461111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO44483Medicare ID - Type Unspecified