Provider Demographics
NPI:1447597257
Name:MILLER, MELISSA ROSE (DC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ROSE
Last Name:MILLER
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 1:205 CREAMERY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKTONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:14817-9787
Mailing Address - Country:US
Mailing Address - Phone:570-702-3099
Mailing Address - Fax:
Practice Address - Street 1:402 N CAYUGA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4291
Practice Address - Country:US
Practice Address - Phone:607-233-4445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010765111N00000X
NYX012399-1111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor