Provider Demographics
NPI:1871622860
Name:MILLER, TERESA LOUISE (DC)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:LOUISE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:LOUISE
Other - Last Name:MILLER HAYDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:520 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3230
Mailing Address - Country:US
Mailing Address - Phone:509-520-8494
Mailing Address - Fax:
Practice Address - Street 1:120 E BIRCH ST STE 12
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3054
Practice Address - Country:US
Practice Address - Phone:509-522-2202
Practice Address - Fax:509-522-2202
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034212111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U95654Medicare UPIN
WA8852037Medicare ID - Type Unspecified