Healthcare Provider Details

I. General information

NPI: 1437397502
Provider Name (Legal Business Name): BRENDA L MIANO D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3538 JAMIESON AVE
SAINT LOUIS MO
63139-2103
US

IV. Provider business mailing address

3538 JAMIESON AVE
SAINT LOUIS MO
63139-2103
US

V. Phone/Fax

Practice location:
  • Phone: 314-503-4000
  • Fax:
Mailing address:
  • Phone: 314-503-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number2000147045
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: