Provider Demographics
NPI:1750969549
Name:MIRET, BIANCA ELISE (DC)
Entity type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:ELISE
Last Name:MIRET
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 1:6001 BEALE LOOP
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-3473
Mailing Address - Country:US
Mailing Address - Phone:772-208-7889
Mailing Address - Fax:
Practice Address - Street 1:6511 CREEDMOOR RD STE 102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1687
Practice Address - Country:US
Practice Address - Phone:919-725-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor