Healthcare Provider Details

I. General information

NPI: 1952425530
Provider Name (Legal Business Name): JOHN ANTHONY MIRELES III D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WILFORD HALL LOOP, BLDG 4554
JBSA LACKLAND AFB TX
78236-9908
US

IV. Provider business mailing address

1100 WILFORD HALL LOOP BLDG 4554
JBSA LACKLAND AFB TX
78236-9908
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-3715
  • Fax:
Mailing address:
  • Phone: 210-292-3715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8370
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: