Provider Demographics
NPI:1295015626
Name:MILLER, VIRGIL THOMAS (LAC)
Entity Type:Individual
Prefix:MR
First Name:VIRGIL
Middle Name:THOMAS
Last Name:MILLER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 E SNOHOMISH AVE
Mailing Address - Street 2:APTARTMENT. A
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-5714
Mailing Address - Country:US
Mailing Address - Phone:907-376-7284
Mailing Address - Fax:
Practice Address - Street 1:545 N KNIK ST
Practice Address - Street 2:UNIT B
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7022
Practice Address - Country:US
Practice Address - Phone:907-357-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK134171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist