Provider Demographics
NPI:1346590247
Name:MILES, ANDREW (LAC, DOM)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:MILES
Suffix:
Gender:M
Credentials:LAC, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 LOLA DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3744
Mailing Address - Country:US
Mailing Address - Phone:505-393-5556
Mailing Address - Fax:
Practice Address - Street 1:8338 COMANCHE RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-2304
Practice Address - Country:US
Practice Address - Phone:505-393-5556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC159739171100000X
NM1182171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist