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General NPI Number Information
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NPI Number | 1134455983
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Entity Type | Organization
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Legal Business Name | MILES FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 10/29/2009
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Last Update Date | 10/29/2009
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Provider Practice Location Address
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Address Line | 794 W. MAIN STREET
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City | RIDGELAND
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State | SC
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Zip | 29936-6317
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Country | US
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Telephone | 843-645-0888
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Fax | 843-645-0889
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Provider Business Mailing Address
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Address Line | PO BOX 2034
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City | RIDGELAND
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State | SC
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Zip | 29936-6317
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Country | US
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Telephone | 843-645-0888
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Fax | 843-645-0889
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Authorized Official
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Title or Position | BILLING COORDINATOR
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Name | PAUL ROTHWELL
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Credential |
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Telephone | 604-599-1895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | SC3376
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License Number State | SC
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