MEDICARE: DR. KEVIN SHAWN MILLET D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NI0900X	Internist Chiropractor	90-175-867-1202	UT

General Provider Information

NPI Number	:	1609851088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN SHAWN MILLET D.C.

Provider Business Mailing Address
First Line	:	3335 S 900 E
Second Line	:	STE 130
City	:	SLC
State	:	UT
Zip	:	84106-2189
Country	:	US
Telephone Number	:	801-486-6261
Fax Number	:	801-486-6261

Provider Business Practice Location Address
First Line	:	3335 S 900 E
Second Line	:	STE 130
City	:	SLC
State	:	UT
Zip	:	84106-2189
Country	:	US
Telephone Number	:	801-486-6261
Fax Number	:	801-486-6261

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	07/08/2007

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