MEDICARE: DR. PENNY LYNNETTE MILES DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC-005423L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831173947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PENNY LYNNETTE MILES DC

Provider Business Mailing Address
First Line	:	5947 STATE ROUTE 655
Second Line	:	SUITE A
City	:	BELLEVILLE
State	:	PA
Zip	:	17004-9242
Country	:	US
Telephone Number	:	814-441-5206
Fax Number	:

Provider Business Practice Location Address
First Line	:	5947 STATE ROUTE 655
Second Line	:	SUITE A
City	:	BELLEVILLE
State	:	PA
Zip	:	17004-9242
Country	:	US
Telephone Number	:	814-441-5206
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	05/20/2024

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