Provider Demographics
NPI:1306320742
Name:MILLER, JESSICA ANNE (DC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
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 1:2311 WAKARUSA DR STE C
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-3350
Mailing Address - Country:US
Mailing Address - Phone:573-301-5465
Mailing Address - Fax:833-300-9392
Practice Address - Street 1:2311 WAKARUSA DR STE C
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-3350
Practice Address - Country:US
Practice Address - Phone:573-301-5465
Practice Address - Fax:833-300-9392
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05933111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor