Healthcare Provider Details

I. General information

NPI: 1508124157
Provider Name (Legal Business Name): DR. RANDY SCOTT MILAND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 CENTERVILLE CIR
VADNAIS HEIGHTS MN
55127-6344
US

IV. Provider business mailing address

4215 NICOLLET AVE APT 9
MINNEAPOLIS MN
55409-2063
US

V. Phone/Fax

Practice location:
  • Phone: 651-429-3015
  • Fax:
Mailing address:
  • Phone: 612-237-7845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1568
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: