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General NPI Number Information
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NPI Number | 1508124157
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Entity Type | Individual
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Provider Name | DR. RANDY SCOTT MILAND
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Gender | Male
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Dates
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Enumeration Date | 05/01/2012
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Last Update Date | 05/01/2012
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Provider Practice Location Address
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Address Line | 1060 CENTERVILLE CIR
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City | VADNAIS HEIGHTS
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State | MN
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Zip | 55127-6344
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Country | US
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Telephone | 651-429-3015
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Fax |
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Provider Business Mailing Address
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Address Line | 4215 NICOLLET AVE APT 9
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City | MINNEAPOLIS
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State | MN
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Zip | 55409-2063
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Country | US
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Telephone | 612-237-7845
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1568
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License Number State | MN
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