Provider Demographics
NPI:1295846640
Name:GATES, ALISA M (DC)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:M
Last Name:GATES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 BERKMAR CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1464
Mailing Address - Country:US
Mailing Address - Phone:434-220-3400
Mailing Address - Fax:
Practice Address - Street 1:676 BERKMAR CIR
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1464
Practice Address - Country:US
Practice Address - Phone:434-220-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001990111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor