Provider Demographics
NPI:1912612599
Name:MILLER, KRISTIN L (DC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
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:N343 SWIFT RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53098-4820
Mailing Address - Country:US
Mailing Address - Phone:920-342-8593
Mailing Address - Fax:
Practice Address - Street 1:5359 MOUNES ST STE E
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-3380
Practice Address - Country:US
Practice Address - Phone:504-688-3835
Practice Address - Fax:504-766-6973
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1975111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor