Provider Demographics
NPI:1831173947
Name:MILES, PENNY LYNNETTE (DC)
Entity type:Individual
Prefix:DR
First Name:PENNY
Middle Name:LYNNETTE
Last Name:MILES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5947 STATE ROUTE 655
Mailing Address - Street 2:SUITE A
Mailing Address - City:BELLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17004-9242
Mailing Address - Country:US
Mailing Address - Phone:814-441-5206
Mailing Address - Fax:
Practice Address - Street 1:5947 STATE ROUTE 655
Practice Address - Street 2:SUITE A
Practice Address - City:BELLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:17004-9242
Practice Address - Country:US
Practice Address - Phone:814-441-5206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-005423L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015146990003Medicaid
PA46463Medicare UPIN
PA0015146990003Medicaid