1639375629 NPI number — DR. KENNETH J MILLER D.C.

Table of content: DR. KENNETH J MILLER D.C. (NPI 1639375629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639375629 NPI number — DR. KENNETH J MILLER D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
KENNETH
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639375629
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1463
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHRISTIANSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24068-1463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-951-6900
Provider Business Mailing Address Fax Number:
540-951-8900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2445 E WASHINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
VINTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24179-1589
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-890-1444
Provider Business Practice Location Address Fax Number:
540-890-1131
Provider Enumeration Date:
06/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2007015101 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 0104555572 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2007015101 . This is a "MO - LICENSE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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