Provider Demographics
NPI:1316774318
Name:MILLISON, ALEXANDRA (DC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:MILLISON
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 1:413 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-3034
Mailing Address - Country:US
Mailing Address - Phone:918-527-2707
Mailing Address - Fax:
Practice Address - Street 1:2010 VANCOUVER STREET
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-9100
Practice Address - Country:US
Practice Address - Phone:918-409-0654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4598111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor