Provider Demographics
NPI:1093737926
Name:MILES OF CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:MILES OF CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-538-2062
Mailing Address - Street 1:2450 S SHORE BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2996
Mailing Address - Country:US
Mailing Address - Phone:281-538-2062
Mailing Address - Fax:281-538-6309
Practice Address - Street 1:2450 S SHORE BLVD
Practice Address - Street 2:STE 200
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2994
Practice Address - Country:US
Practice Address - Phone:281-538-2062
Practice Address - Fax:281-538-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8718111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0027NEOtherBLUE CROSS BLUE SHIELD
TX7127260OtherAETNA INSURANCE
TXDC8718OtherWORKERS COMP
TX=========OtherTAX ID
TXDC8718OtherWORKERS COMP
TX00Y813Medicare PIN