Provider Demographics
NPI:1003185810
Name:BANDALO, MIRO (DC)
Entity type:Individual
Prefix:MR
First Name:MIRO
Middle Name:
Last Name:BANDALO
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 1:7149 NOLENSVILLE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NOLENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37135
Mailing Address - Country:US
Mailing Address - Phone:615-819-0587
Mailing Address - Fax:615-819-0649
Practice Address - Street 1:7149 NOLENSVILLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:NOLENSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37135
Practice Address - Country:US
Practice Address - Phone:615-819-0587
Practice Address - Fax:615-819-0649
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2652111N00000X
CADC32149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor