# DR. LARISSA MARIE TILLEY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1912278730
- **Gender:** F
- **Credential:** D.C.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 2012002407 | MO | — |
| 111N00000X | Chiropractor | 2595 | TN | — |
| 111N00000X | Chiropractor | 4404 | OH | Yes |

## Other

- **Enumeration date:** 01/25/2012
- **Last updated:** 10/22/2013