Provider Demographics
NPI:1104923127
Name:MILES, BEVERLY JEAN (DC)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:JEAN
Last Name:MILES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 TORREY PINES DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4827
Mailing Address - Country:US
Mailing Address - Phone:573-443-2761
Mailing Address - Fax:573-443-2761
Practice Address - Street 1:1301 TORREY PINES DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4827
Practice Address - Country:US
Practice Address - Phone:573-443-2761
Practice Address - Fax:573-443-2761
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002607111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition