Provider Demographics
NPI:1205845179
Name:MILES, PAUL DAVID III (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DAVID
Last Name:MILES
Suffix:III
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 1:4845 HIXSON PIKE
Mailing Address - Street 2:STE E
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4466
Mailing Address - Country:US
Mailing Address - Phone:423-875-8786
Mailing Address - Fax:423-875-5583
Practice Address - Street 1:4845 HIXSON PIKE
Practice Address - Street 2:STE E
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4466
Practice Address - Country:US
Practice Address - Phone:423-875-8786
Practice Address - Fax:423-875-5583
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001921111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3970542Medicare ID - Type Unspecified
U52648Medicare UPIN