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General NPI Number Information
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NPI Number | 1023178811
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Entity Type | Organization
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Legal Business Name | SKI BOLD PROFESSIONAL ASSOCIATION
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 417 SW MILITARY DR
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City | SAN ANTONIO
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State | TX
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Zip | 78221-1619
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Country | US
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Telephone | 210-923-3341
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Fax | 210-924-9115
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Provider Business Mailing Address
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Address Line | 417 SW MILITARY DR
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City | SAN ANTONIO
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State | TX
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Zip | 78221-1619
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Country | US
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Telephone | 210-923-3341
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Fax | 210-924-9115
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN D. MILLER
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Credential | D.C.
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Telephone | 210-923-3341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0200X
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Taxonomy Name | Radiology Chiropractor
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License Number | 4487
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License Number State | TX
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