Provider Demographics
NPI:1114196219
Name:GOINS, MILES A (DC)
Entity Type:Individual
Prefix:DR
First Name:MILES
Middle Name:A
Last Name:GOINS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 E LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-3556
Mailing Address - Country:US
Mailing Address - Phone:573-975-9824
Mailing Address - Fax:573-581-2446
Practice Address - Street 1:2709 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-3556
Practice Address - Country:US
Practice Address - Phone:573-975-9824
Practice Address - Fax:573-581-2446
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11188111N00000X
MO2011039597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor