Provider Demographics
NPI:1013771542
Name:MILLER, ALISSA R (DC)
Entity Type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:R
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 1:170 S 2ND ST STE 205
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-1673
Mailing Address - Country:US
Mailing Address - Phone:541-290-8696
Mailing Address - Fax:
Practice Address - Street 1:170 S 2ND ST STE 205
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-1673
Practice Address - Country:US
Practice Address - Phone:541-290-8696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor