Provider Demographics
NPI:1598880478
Name:WILTSE, MILES RALPH (DC)
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:RALPH
Last Name:WILTSE
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 1:6449 KIRKVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-1600
Mailing Address - Country:US
Mailing Address - Phone:315-433-0077
Mailing Address - Fax:315-433-1294
Practice Address - Street 1:6449 KIRKVILLE ROAD
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-1600
Practice Address - Country:US
Practice Address - Phone:315-433-0077
Practice Address - Fax:315-433-1294
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0064451111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC064453OtherWORKERS COMPENSATION
NYC064453OtherWORKERS COMPENSATION