Provider Demographics
NPI:1619176658
Name:MILLER-ROMERO, TISHA MANETTE (DC)
Entity Type:Individual
Prefix:DR
First Name:TISHA
Middle Name:MANETTE
Last Name:MILLER-ROMERO
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 1:320 E MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3102
Mailing Address - Country:US
Mailing Address - Phone:970-484-7527
Mailing Address - Fax:970-484-7521
Practice Address - Street 1:320 E MULBERRY ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3102
Practice Address - Country:US
Practice Address - Phone:970-484-7527
Practice Address - Fax:970-484-7521
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODC4739111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor