Provider Demographics
NPI:1659503738
Name:MILLER, TIMOTHY KIRK (LMP, LAC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:KIRK
Last Name:MILLER
Suffix:
Gender:M
Credentials:LMP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 NE 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5562
Mailing Address - Country:US
Mailing Address - Phone:206-267-0863
Mailing Address - Fax:206-267-0814
Practice Address - Street 1:902 NE 65TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5562
Practice Address - Country:US
Practice Address - Phone:206-267-0863
Practice Address - Fax:206-267-0814
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60102377171100000X
WAMA60082855225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171100000XOther Service ProvidersAcupuncturist