Provider Demographics
NPI:1356530513
Name:MILLER, VANESSA ELAINE (LMP)
Entity type:Individual
Prefix:MISS
First Name:VANESSA
Middle Name:ELAINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 N 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-3314
Mailing Address - Country:US
Mailing Address - Phone:253-985-5418
Mailing Address - Fax:253-835-1491
Practice Address - Street 1:2112 N 29TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-3314
Practice Address - Country:US
Practice Address - Phone:253-985-5418
Practice Address - Fax:253-835-1491
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor