Healthcare Provider Details

I. General information

NPI: 1124658976
Provider Name (Legal Business Name): KELSIE ANN MILLER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 HARROLD ST APT 1152
FORT WORTH TX
76107-3000
US

IV. Provider business mailing address

411 HARROLD ST APT 1152
FORT WORTH TX
76107-3000
US

V. Phone/Fax

Practice location:
  • Phone: 210-845-9444
  • Fax:
Mailing address:
  • Phone: 210-845-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number14295
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: