Provider Demographics
NPI:1154349934
Name:MILLER, KIM M (DC)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:M
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 1:1022 N JESSE JAMES RD
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64024-1202
Mailing Address - Country:US
Mailing Address - Phone:816-630-6676
Mailing Address - Fax:816-630-6676
Practice Address - Street 1:1022 N JESSE JAMES RD
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-1202
Practice Address - Country:US
Practice Address - Phone:816-630-6676
Practice Address - Fax:816-630-6876
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004015347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOS53D748Medicare ID - Type UnspecifiedMEDICARE ITEM #
MOS530000Medicare PIN
MOV04428Medicare UPIN