Individual
DR. KENNETH ROBERT TILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
7890 MAIN, BIRCH RUN, MI 48415
(989) 624-6266
(989) 624-4407
Mailing address
PO BOX 399, 7890 MAIN, BIRCH RUN, MI 48415
(989) 624-6266
(989) 624-4407
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301005216
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2928135
—
MI
01
—
391945651
AETNA
MI
01
—
950G35246
BCBS
MI
Enumeration date
10/05/2006
Last updated
07/12/2010
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