Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | X00996-1 | NY |
NPI | 1003840711 |
---|---|
Provider Name | Dr. Kim C Miller |
First Address | Vestal, NY 13850-1562 |
Second Address | Vestal, NY 13850-1562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 12/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000143666 | BC/BS (01) | NY |
100651380167 | CDPHP (01) | NY |