Provider Demographics
NPI:1801918461
Name:MILLER, KERRY L (DC)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:L
Last Name:MILLER
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 1:369 MONTEZUMA AVE
Mailing Address - Street 2:172
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-2626
Mailing Address - Country:US
Mailing Address - Phone:505-603-8090
Mailing Address - Fax:
Practice Address - Street 1:138 W CORONADO RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2610
Practice Address - Country:US
Practice Address - Phone:505-820-1466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor