Provider Demographics
NPI:1841213816
Name:MILES, JAMIE L (DC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:MILES
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 1:3027 MARINA BAY DR
Mailing Address - Street 2:STE 105
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2772
Mailing Address - Country:US
Mailing Address - Phone:281-538-2062
Mailing Address - Fax:281-538-6309
Practice Address - Street 1:3027 MARINA BAY DR
Practice Address - Street 2:STE 105
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2772
Practice Address - Country:US
Practice Address - Phone:281-538-2062
Practice Address - Fax:281-538-1046
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8718111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDC8718OtherWORKERS COMP
TX8U7930OtherBCBS
TX470947661OtherTAX ID
TX7127260OtherAETNA INSURANCE
TX7127260OtherAETNA INSURANCE
TX8U7930OtherBCBS