Provider Demographics
NPI:1295831469
Name:MIES, JEFFREY M (DC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:MIES
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 1:1747 7TH ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4047
Mailing Address - Country:US
Mailing Address - Phone:320-251-0822
Mailing Address - Fax:320-202-0602
Practice Address - Street 1:1747 7TH ST S
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4047
Practice Address - Country:US
Practice Address - Phone:320-251-0822
Practice Address - Fax:320-202-0602
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2962111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3C433MIOtherBLUE CROSS BLUE SHIELD