Provider Demographics
NPI:1366459620
Name:WILES, JOSEPH ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ALLEN
Last Name:WILES
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 1:1191 ROUTE 9W
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12542-5421
Mailing Address - Country:US
Mailing Address - Phone:845-236-9162
Mailing Address - Fax:845-839-2844
Practice Address - Street 1:1191 ROUTE 9W
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NY
Practice Address - Zip Code:12542-5421
Practice Address - Country:US
Practice Address - Phone:845-236-9162
Practice Address - Fax:845-236-9154
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011071-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400010220Medicare PIN