Provider Demographics
NPI:1720312473
Name:MILES, PATRICK T (DC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:T
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 1:850 HIGH ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-3739
Mailing Address - Country:US
Mailing Address - Phone:413-536-0142
Mailing Address - Fax:413-536-0607
Practice Address - Street 1:850 HIGH ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-3739
Practice Address - Country:US
Practice Address - Phone:413-536-0142
Practice Address - Fax:413-536-0607
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA158479OtherHARVARD PILGRIM
00003114577 03OtherUNITED HEALTHCARE
0506467OtherNEIGHBORHOOD HEALTH PLAN
9231388OtherAETNA
MA110084996AMedicaid
742223OtherOPTUMHEALTH GROUP
742223OtherOPTUMHEALTH GROUP