Provider Demographics
NPI:1497171474
Name:SLEDD, MILES (LAC)
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:
Last Name:SLEDD
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 NW COUCH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-4018
Mailing Address - Country:US
Mailing Address - Phone:503-253-3443
Mailing Address - Fax:503-445-0949
Practice Address - Street 1:75 NW COUCH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-4018
Practice Address - Country:US
Practice Address - Phone:503-253-3443
Practice Address - Fax:503-445-0949
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC807171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist