Provider Demographics
NPI:1982091187
Name:MILLER, CHARLES ALLISON (LAC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ALLISON
Last Name:MILLER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 WOODHURST DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2313
Mailing Address - Country:US
Mailing Address - Phone:757-793-0633
Mailing Address - Fax:
Practice Address - Street 1:129 W VIRGINIA BEACH BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2030
Practice Address - Country:US
Practice Address - Phone:757-793-0633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-25
Last Update Date:2015-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000760171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist