Provider Demographics
NPI:1124658976
Name:MILLER, KELSIE ANN (DC)
Entity type:Individual
Prefix:DR
First Name:KELSIE
Middle Name:ANN
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 1:411 HARROLD ST APT 1152
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3000
Mailing Address - Country:US
Mailing Address - Phone:210-845-9444
Mailing Address - Fax:
Practice Address - Street 1:411 HARROLD ST APT 1152
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-3000
Practice Address - Country:US
Practice Address - Phone:210-845-9444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14295111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner