MEDICARE: JOHN ANTHONY MIRELES III D.C.

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	8370	TX

General Provider Information

NPI Number	:	1952425530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ANTHONY MIRELES III D.C.

Provider Business Mailing Address
First Line	:	1100 WILFORD HALL LOOP BLDG 4554
Second Line	:
City	:	JBSA LACKLAND AFB
State	:	TX
Zip	:	78236-9908
Country	:	US
Telephone Number	:	210-292-3715
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 WILFORD HALL LOOP, BLDG 4554
Second Line	:
City	:	JBSA LACKLAND AFB
State	:	TX
Zip	:	78236-9908
Country	:	US
Telephone Number	:	210-292-3715
Fax Number	:

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	06/10/2022

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